What is a 'safe supply' of drugs and how would it work?

Federal and provincial governments agree the death toll from opioid overdoses amounts to a national health crisis.

In British Columbia — where the situation has been declared a public emergency — advocates say a "safe supply" of drugs is needed.

CBC takes a look at how that might work.

What do we mean by 'safe supply'?

Exactly what it sounds like. In a February 2019 'concept document' provided to Vancouver City Council, the Canadian Association of People Who Use Drugs describes "safe supply" as "a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market."

The supply would include heroin and other opioids, cocaine, crystal methamphetamine, hallucinogens such as MDMA and LSD, and marijuana — free of charge.

Why do advocates say it's needed?

Thousands of Canadians have lost their lives to the opioid crisis in recent years. The dead include people of all ages from every walk of life.

Last July, the City of Vancouver approved a "safe supply statement" to share with other levels of government and to advocate for access to a regulated drug supply.

"We often hear this crisis referred to as an overdose crisis, but really, we are in a drug poisoning crisis," the statement reads.

"One of the primary causes of overdose is the contamination of the illicit drug supply, and we believe that future deaths could be prevented if people could access a regulated safe supply."

How would it work?

No definitive model has been agreed upon, but Donald MacPherson, executive director of the Canadian Drug Policy Coalition, says drugs could be supplied to users through any number of channels.

Those include supervised consumption sites, doctors' offices and pharmacies. The idea of dispensing drugs through a form of vending machine has also been suggested.

"It's what we do anyway," MacPherson says.

"We dispense truckloads of drugs every day through the pharmacy system. So dispensing drugs is not something that's new to us. We need to get our heads around dispensing these other drugs … for a reason other than treatment."

Where would the drugs come from?

MacPherson says pharmaceutical companies have the ability to produce any type of drug that would be needed for a safe supply.

Who would qualify — and how?

Safe supply advocates want a low bar for qualification because the higher the hurdle to access the more likely it is the drugs would remain out of reach of the people who need it most.

"Most models have some level of diagnosis or engagement with a health-care provider to ascertain what kind of substance user you are," says MacPherson.

"Whether you have substance-use disorder. Whether you're diagnosed as someone with an addiction. Or whether you're someone who doesn't have an addiction but you use on the weekend."

Dr. Christy Sutherland — medical director of the Portland Hotel Society, a Vancouver-based advocacy group — says 60 per cent of opioid fatalities in the Vancouver region were not daily opioid users.

That figure included stimulant users trying to come down after staying awake for days on end and heavy drinkers trying to kick alcohol.

That means models that include only diagnosed opioid addicts would miss many of the targets of a safe drug supply, she says. 

But what about the kids?

Would your adult teenaged son or daughter be able to get their hands on free cocaine?

MacPherson acknowledges the debate these questions raise.

But if an 18-year-old is going to try drugs, he asks, wouldn't any parent want to do what they can to ensure the drugs are safe?

Should the state be 'enabling' someone's addiction?

Critics like McMaster University psychiatry resident Jeremy Devine argue that people struggling with opioid addiction need compassion, dignity and respect.

But he questions the wisdom of dispensing free drugs.

"Activists and drug policy leaders, in their zeal to undermine the previous 'war on drugs' or the criminal justice approach to addiction, are unwittingly creating a prison system of their own: a mental prison of perpetual, state-sponsored drug use," Devine wrote in the July issue of Policy Options. 

"This prison is even more insidious because it purports to offer treatment while keeping patients trapped in their addiction."

Sutherland rejects the idea that providing users with safe drugs is "enabling" them.

She says that belief is tied to a worldview that says people should be punished for taking drugs.

Is anyone already providing a safe supply? 

British Columbia is experimenting with two forms of safe supply program, both of which are available to people with an opioid addiction who are also intravenous drug users.

In the first, participants must attend a clinic several times a day and inject prescribed drugs under the supervision of a nurse.

The second is more flexible. It's tailored to fit the schedule and needs of the users, who receive a form of tablet they can inject, snort or swallow in a supervised setting.

What about the law?

The sale, production and distribution of drugs in Canada is governed by the federal Controlled Drugs and Substances Act.

But people can apply for exemptions under Section 56 of the act, which says that the minister of health can issue an exemption if it's deemed "necessary for a medical or scientific purpose or is otherwise in the public interest."

Previous exemptions have been issued for scientific research as well as the distribution of methadone.

The legislation also details provisions for exemptions granted for supervised consumption sites.

The campaign for a safe supply of drugs has been compared to the battle over Insite, the supervised injection site in Vancouver's Downtown Eastside.

The former federal Conservative government fought Insite all the way to the Supreme Court of Canada.

Will this fight end up in court?

That's hard to say. Scott Bernstein — director of Policy with the Canadian Drug Policy Coalition, and one of the lawyers who fought for Insite — says the courts don't grant "positive rights" — meaning they won't order the provision of a particular medical service or treatment.

Instead, they have ruled on the attempts to take rights away, like when, the Supreme Court ended Ottawa's eight-year fight to shut down Insite, finding it had been "proven to save lives with no discernable negative impact on the public safety and health objectives of Canada."

Canada's top court said denying users of Insite was an infringement of their charter right to "life, liberty and security of person."

A similar argument could be envisioned if police charged someone with distributing drugs for a heroin compassion club or for running an unlicensed safe supply site.

So the bottom line is that unless Ottawa grants an exemption, it will take some form of legal confrontation or civil disobedience to move the safe supply debate from the public arena to the courts.