IN DEPTH: Are Canadian Teens Getting Hooked on ‘Safer Supply’ Drugs?

Needles are seen on the ground in Oppenheimer park in Vancouver's Downtown Eastside in a file photo. The Canadian Press/Jonathan Hayward

Addictions experts and authorities agree that some of the government-provided “safer supply“ opioids are being diverted—that is, sold or given away to others rather than taken by the drug addicts to whom they are prescribed ”as a safer alternative to the toxic illegal drug supply.”

There’s disagreement, however, on how much is being diverted and whether it has become a gateway drug for youth to fall into opioid addiction. This contentious point is a wedge in Canada’s political and social divide on the “safer supply” approach to the overdose crisis.

The Epoch Times took a look at much of the available data, along with other evidence for and against a teen “dilly” problem. Dilly is the street name of Dilaudid, a brand name for the safer supply opioid hydromorphone. Other drugs in the opioid class include fentanyl, morphine, oxycodone, heroin, and codeine.

Dilaudid is a registered trademark of Purdue Pharma, the company pegged among those largely responsible for the opioid crisis that began in the 1990s, mostly due to its OxyContin prescription painkiller. OxyContin is Purdue’s brand name for the opioid drug oxycodone. Purdue is one of several companies selling hydromorphone pills in Canada, and the preferred source for safer supply.

Some doctors have raised the alarm, saying Dilaudid is the new OxyContin, fuelling a new addiction crisis. They say it’s appealing to Canadian youth—it’s now very cheap and it seems relatively safe, as the government’s “safer supply” designation suggests.

A hydromorphone pill costs only about $1 on the street in London, Ontario, where a safer supply program has been running since 2016, says Sharon Koivu, an addictions specialist and researcher at London Health Sciences Centre.

“Opioids were not a high school recreational drug prior to safe supply. Hydromorphone is now,” Dr. Koivu told The Epoch Times via email. “Safe supply has magnified our opioid use.”

She has been vocal on the issue for some time now, but says her complaints have fallen on deaf ears within the safer supply program. Safe supply proponents say hydromorphone is needed to give people an alternative to fentanyl or fentanyl-laced drugs sold on the street, to prevent overdoses.

Mark Mallet, a hospitalist in Victoria, British Columbia, also recently raised the alarm on hydromorphone diversion and discussed why some are reticent to address the issue.

“As a doctor and as a parent, I hear story after story of how the province’s unwitnessed safe-supply program is drawing our young people into the dark world of the opioid epidemic. Every user has a story about the first opioid they tried, and for too many people, that opioid came from a pharmacy,” Dr. Mallet wrote in an op-ed for The Globe and Mail in September.

As a physician whose primary focus is the general medical care of hospitalized patients, Dr. Mallet said evidence is dismissed as “anecdotal” because not enough hard data has been collected.

“An ‘absence of evidence’ could mean that no one has been collecting it. An ‘absence of evidence’ could also just mean that public-health officials are failing to look for it in the right places,” he wrote. “As the death toll continues to mount and our youth are literally dying while we wait for data, the anecdotes must be seen as evidence enough.”

The Data

The Epoch Times asked Health Canada for data related to youth hydromorphone use, and to what extent the ministry is aware of safer supply drugs being diverted to youth.

A woman injects hydromorphone at the Providence Health Care Crosstown Clinic in the Downtown Eastside of Vancouver, B.C., on April 6, 2016. The Canadian Press/Darryl Dyck

Health Canada pointed to two surveys that monitor youth drug use. One, the Canadian Alcohol and Drugs Survey (CADS), looks at drug use for Canadians aged 15 and older. The most recent CADS report available publicly is from 2019, before safer supply initiatives expanded.

The federal government started funding safer supply pilots across the country in 2020, though safer supply existed before then, such as through the pioneering Safer Opioid Supply Program in London started in 2016 by the provincially funded InterCommunity Health Centre. B.C. also implemented a new provincial program in 2020.

The other survey referenced by Health Canada is the Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS), which similarly only has data available up to 2019. Its 2021–2022 results have been removed from the Health Canada website “pending corrections.”

The Epoch Times followed up with Health Canada to see if any more recent data is available, but didn’t receive a reply by press time. The 2019 CADS did not have data for “problematic use of opioids” for youth aged 15 to 19.

The 2019 CSTADS does not have statistics specifically on youth hydromorphone use, though it shows that about 3 percent of students used prescribed pain relievers—oxycodone, fentanyl, and others—to get high. That’s a small percentage compared to the 20.6 percent of youth using opioid painkillers, as reported by a national youth addiction program called Teen Challenge. The program has the statistic on its home page, but it didn’t reply to further inquiry by The Epoch Times before publication.

It seems the currently available youth drug-use data lacks the precision to say how much safer supply hydromorphone young Canadians are using.

Health Canada is supporting a four-year study of safer supply pilots and their short-term outcomes; the results will be available in 2025. B.C.’s Ministry of Mental Health and Addictions told The Epoch Times it is also supporting new studies into how safer supply is working, including diversion.

It said that in the meantime clinicians may take action to prevent diversion, including prescribing less and monitoring use, such as by taking urine samples to see if the patient is taking the hydromorphone or requiring witnessed consumption.

“Data from the BC Centre for Disease Control (BCCDC) does not indicate there has been an increase in opioid use disorder diagnoses among youth. However, we remain committed to listening to families and are working hard to address their concerns,” the ministry said via email.

A June BCCDC report on youth opioid use shows no increase in diagnoses, but it notes that data has limitations, as it includes only those who are hospitalized or have other specific encounters with the public health system related to opioid addiction. Health Canada’s CADS, on the other hand, is based on a broad survey of Canadians.

“Results are descriptive. Additional work is needed to examine the association between rates of new OUD [opioid-use disorder] diagnosis and prescribed safer supply availability across age groups in BC,” the BCCDC report says. It adds that “Many factors impact how likely people are to receive a diagnosis for OUD.”

B.C. Coroners data shows fentanyl and its analogues continue to be the leading cause of unregulated drug deaths, the ministry said in its email. But Dr. Mallet noted that hydromorphone isn’t necessarily what’s killing teens. Rather, hydromorphone may be drawing them into opioid addiction, which escalates into seeking the more potent high of fentanyl.

Drug trafficking data on hydromorphone can also give an indication of what might be happening with the safer supply drug.

Police Reports

It’s worth noting how safe supply hydromorphone sales are said to happen. It seems safer supply hydromorphone is often sold not far from the pharmacy where it was obtained, and it is legal. It is thus less likely than illicit drugs to be seized in a drug bust.

Documentary filmmaker Aaron Gunn told The Epoch Times earlier this year about safer supply prescription labels he saw littering the street outside a pharmacy in Nanaimo, B.C. Patients with prescriptions for hydromorphone peel off the labels before selling the drugs to others on the street, he said. He documented this and other evidence of diversion in his film “Canada Is Dying,” released in May.

The RCMP logo is seen outside Royal Canadian Mounted Police "E" Division Headquarters, in Surrey, B.C., in a file photo. The Canadian Press

Dr. Koivu said she lives near a pharmacy that distributes safer supply drugs and has seen the area deteriorate as addicts moved closer to the pharmacy, “where much of the diversion takes place.”

Many of the people who receive hydromorphone prescriptions are vulnerable, she said, and often forced by others to give up their pills.

Hydromorphone is sometimes trafficked from cities with safer supply programs to cities without, according to reporting by the National Post’s Adam Zivo. The drug can fetch higher prices in these other regions where it’s not as readily available.

Federally funded safer supply pilot programs are now in 29 locations, mostly concentrated in Ontario and B.C.

Police reports of drug busts in both provinces list hydromorphone among other drugs seized. The Epoch Times followed up on one such report in Niagara, Ontario, asking Niagara Regional Police Service what officers there are seeing as far as hydromorphone trafficking goes and whether they’re aware of teens buying it.

The service’s Opioid Enforcement and Education Unit replied briefly via email that not enough data is available to say whether hydromorphone trafficking is on the rise. “At this time we cannot suggest or deny that vulnerable populations such as our youth are the recipients of said drugs.”

The RCMP told The Epoch Times that hydromorphone has been trafficked for the past 10-plus years in Canada but has waned in popularity with the rise of fentanyl. Before safer supply, hydromorphone was prescribed as a painkiller and some of it was diverted to the streets then.

Hydromorphone is highly addictive. It causes the release of large amounts of dopamine in the brain, creating pleasurable feelings, and the brain begins to produce less dopamine on its own, making users reliant on the drug, according to AddictionCenter.com.

Dr. Koivu disputes claims that safer supply hasn’t significantly changed the amount of hydromorphone on the street.

“The amount of prescription opioids on the street was far less and much more expensive prior to safe supply,” she said. “People tell me they buy safe supply. People tell me they sell safe supply. Opioids prescribed for pain have decreased. From everything I see, safe supply is the main source of street hydromorphone in London.”

A drug dealer in B.C. tells a similar story. Before safer supply, hydromorphone tablets sold for about $5 a tablet, and after an increase of supply due to the program, the price dropped to $2, the dealer said in an interview published in the BC Medical Journal in 2021.

Going only by the name John Doe, the dealer answered multiple questions about the impacts he saw of the safer supply program.

“He believes that the hydromorphone prescribed in safe supply is not largely used by those who use fentanyl. When asked what he thinks happens to the hydromorphone prescribed in safe supply, he replied, ‘A lot of people sell it to get fentanyl,’” the article states.

He said that the hydromorphone is sold to people who “only use hydromorphone. They don’t use fentanyl.”

The RCMP said it is hard to pinpoint youth as a specified group buying hydromorphone, but that “younger people using drugs tend to use stimulants like cocaine, methamphetamine, and MDMA [often called ecstasy], and less depressants like opioids.” As noted previously, Health Canada data on recent opioid use among youth is sparse.

Health Canada’s Drug Analysis Service (DAS) compiles statistics related to drug seizures by law enforcement across the country. DAS notes that its statistics show the number of drug samples sent in by law enforcement for analysis and may not give a complete picture regarding drug seizures.

Most of the data DAS referred The Epoch Times to is from 2020 to 2023. It shows a relatively higher prevalence of opioids in Ontario and B.C.

It shows that hydromorphone was the third most frequently identified opioid among the 28,666 samples submitted for analysis from July to September 2023, after fentanyl and para-fluorofentanyl. It came in above oxycodone and heroin. OxyContin is a brand name for oxycodone, the prescription painkiller that started the earlier opioid addiction crisis.

A chart plotting the number of samples analyzed from 2012 to 2022, tells the story of a rise in the identification of hydromorphone—especially after 2020. Part of that story is that it has taken the place oxycodone held in 2012.

In 2012, identification of hydromorphone was far below that of oxycodone. Identification of hydromorphone rose fairly steadily until about 2017, and during the same period, identification of oxycodone dropped fairly steadily. From 2017 to 2020, both dipped. In 2020, they both rose, but hydromorphone climbed more quickly and reached almost the same level oxycodone was at in 2012.

Identification of fentanyl was much higher—over six times higher than hydromorphone in 2022.

Dr. Koivu argues that a rise in safer supply opioids has driven the rise in fentanyl. Hydromorphone creates and feeds opioid addiction, she said, leading people to eventually seek fentanyl, a stronger opioid.

It’s akin to the proverbial chicken-and-egg argument.

A sign is displayed in front of Health Canada headquarters in Ottawa on Jan. 3, 2014. Sean Kilpatrick/The Canadian Press

“As more people were using [safe supply] opioids, it brought illicit fentanyl to our community,” Dr. Koivu said. “I think it is extremely important to know the program promoted the fentanyl crisis—it was not a response to it. The ’safe supply' advocates are now using the fentanyl crisis to justify the program’s existence.”

Dr. Koivu says she saw the benefits of the program at first. She gave the example of a woman she called Linda, who was a 38-year-old sex worker struggling with addiction. Receiving safer supply helped Linda access other supports, such as HIV treatment, and helped her financially, so she decreased her street work. But, eventually, Dr. Koivu saw the downside of the program.

“I started seeing the problems of diversion, more addiction, younger people using,” she said.

Anecdotes

Media reports have brought to light some stories of young people affected by safer supply, and Dr. Mallet told of some young people he knows.

A 16-year-old girl from Port Coquitlam, B.C., told CTV this summer that she started taking Dilaudid hydromorphone pills two years ago.

“All of a sudden people were doing them, and like my friends would just be like, ‘Oh, I’m on a dilly,’” she said. She said drug dealers market them as safe.

“They tell you that there’s nothing bad in them, that they’re clean drugs that won’t kill you or harm you in any way, that they’re 100 percent dilly,” she said.

The RCMP told The Epoch Times that criminals also create pills that look like pharmaceutical hydromorphone, creating the illusion of safety—though they say it’s not a widespread phenomenon.

Also in Port Coquitlam, CTV reported on a teenage girl named Kamilah who died from a drug overdose in August 2022. Her father, Greg Sword, says she had hydromorphone in her system when she died, as well as MDMA and cocaine. He said officials seemed to be dragging out the investigation.

“They don’t want to face the truth: A decision they made is causing more harm. They want to think that they’re saving people,” he said.

Dr. Mallet says the 18-year-old daughter of one of his friends was offered a dilly at a party in Victoria. She took it, and subsequent use of the drug led her to full-blown opioid addiction. He says she was offered a prescription for more hydromorphone when she went to seek help for her addiction.

He also told the story of a 35-year-old patient of his who got hooked on dillies and is now addicted to fentanyl.

He mentioned a clinic called Cool Aid in Victoria where he says a doctor told him they started scaling back their hydromorphone prescriptions because they realized they were being diverted.

Clinic spokesperson Tracey Robertson told The Epoch Times the clinic doesn’t have a public statement on the issue.

“We have not publicly come forward on the issue and, at this point, we are still in conversations internally,” she said.

The Epoch Times reached out to many youth addiction clinics across Canada and received a reply from only one. A clinic in Thunder Bay, Ontario—where a federally funded safe supply program is in place—declined to comment.

“Unfortunately, we feel this opportunity does not align with our organization’s focus and goals,” St. Joseph’s Care Group said in an email.

Policy-Making

Policy-makers continue to wrangle over safer supply as they wait for more information, anecdotal and empirical, to come in.

Prime Minister Justin Trudeau arrives to a caucus meeting on Parliament Hill in Ottawa on Oct. 4, 2023. The Canadian Press/Sean Kilpatrick

The federal Conservatives introduced a motion in May to put a stop to the safer supply program, but it failed.

During question period on May 10, Prime Minister Justin Trudeau accused Conservative Leader Pierre Poilievre of “ideological fear mongering” on the issue. He said there is evidence safe supply has prevented overdoses and saved lives.

Mr. Poilievre blamed safer supply drugs for an increase in opioid addictions and overdoses. He referred to Mr. Zivo’s article, informed by interviews with dozens of health-care and addiction experts. Mr. Poilievre said the Liberal government is “subsidizing” the opioids “and flooding them into our streets, including through dispensaries.”