A bitter pill: Safer supply program flawed but vital, patient says
Ottawa providers applying for more federal cash amid community outcry
Street drugs have stolen too much from Zachary Wickens.
His girlfriend Bella died three years ago after using alone. Then he lost a friend, so close he was like a brother, who froze to death after taking drugs.
"This whole opiate epidemic is out of control," Wickens said.
Fentanyl almost took his life, too, by the Shoppers Drug Mart on Rideau Street near King Edward Avenue.
"One of my overdoses was so bad that I was dead 10 minutes straight. Flatlined … My heart wasn't beating," he said. "They shocked me, did CPR, saved my life."
Now Wickens is on a safer supply program that runs out of a clinic and pharmacy on that same block.
WATCH | Wickens talks about the pros and cons of the program:
He used to smoke dangerous amounts of fentanyl and overdose multiple times a week. The program prescribes him 24 Dilaudid opioid pills each day in the hopes they'll help him stay off the toxic supply on the street.
The pills are still addictive, but at least he isn't dead.
"It really does help if you use it properly," Wickens said.
Street trade in 'dillies'
That stretch of sidewalk is full of people who don't use the pills properly. When they get them, Wickens said, many trade the Dilaudid for stronger stuff on the street.
"If they don't have their fentanyl they get really sick, and the Dilaudids, they don't even come close to the fentanyl so they basically don't have a choice," he said.
Even if they want to resist, the temptation is there all along the sidewalk in front of the clinic.
The dealers aren't shy. One propositioned a CBC reporter, confirming he will buy "dillies" — slang for Dilaudid — and sell fentanyl.
"There's these predatory people that immediately say 'Hey, I'll give you this dope for your Dilaudids,' and obviously as an addict you're going to say yes," Wickens said.
That matches what police, neighbours and nearby businesses see as a chief shortcoming of Ottawa's safer supply program.
Those critics say they support safer supply — in principle.
In practice, they say they way it's implemented in Ottawa is hurting the neighbourhood and some of the organizations that run it are unresponsive to community concerns.
Funding application has been sent
Now is a key moment.
Health Canada has already given the program $7.7 million through its Substance Use and Addiction Program (SUAP). The money runs out at the end of this month, but proponents have submitted an application for more.
"When I found out they were asking for another SUAP grant, then I said, 'OK wait, we cannot have four more years of this,'" said Rideau-Vanier Coun. Stéphanie Plante, whose ward contains the Rideau Street clinic and pharmacy, as well as a similar facility on Montreal Road.
"This is insane."
A month ago, Plante sent a letter to a senior Health Canada bureaucrat to express her "reservation, concern and a lack of support for this funding application."
In Plante's view, decisions that "overwhelmingly" affect her ward are being made behind closed doors and she isn't clear on what specifically all that money is paying for.
The councillor said the organizations behind the program have refused to share their application with her.
"Why are they allowed to keep these things secret and not engage with the people most affected by whatever moneys they receive?" she asked.
According to Recovery Care, the federal money doesn't pay for visits to doctors that prescribe the drugs. The Ontario Health Insurance Plan (OHIP) does that.
Recovery Care CEO Donna Sarrazin said the Health Canada funding, channelled through a non-profit called Pathways to Recovery, helps six community partners provide wrap-around services such as wound care and housing help to safer supply patients.
Sarrazin, who is also a director of Pathways to Recovery, said new Health Canada funding would support a "beefed up" housing program, and much else besides.
"There'll be programs like shower programs, hygiene programs, education, nutrition — essentials," she said.
Critics left in the dark
Critics feel they have only the faintest idea of how Pathways and Recovery Care operate, along with an interlinked group of pharmacies called Respect RX.
While Pathways is a non-profit, the latter two are for-profit corporations. The three organizations share overlapping directors.
Health Canada confirmed in a statement that partnerships with for-profit groups are acceptable as part of the program.
"SUAP recipients may choose to further distribute a portion of their contribution funding to a partner organization to conduct approved project activities," it said.
Rob Boyd, CEO of program partner Ottawa Inner City Health, said private-public partnerships are completely normal in health care. Sarrazin said any federal funds are dedicated to specific projects, not toward padding the corporate bottom line.
"You can't make profit on a program like this," she said.
Plante has a simple answer to that: show us the documents. She wants to see financial statements and the information the partners are sending to Health Canada.
Sarrazin declined to release those documents when asked by CBC.
"No, we're not required to do that," she said. "We follow all of the required expectations. We're audited externally. It's shared up to Health Canada."
In an emailed response to Coun. Plante Thursday, which she shared with CBC, Health Canada said Pathways to Recovery is in compliance with the requirements of its contribution agreement and with its financial reporting obligations.
More calls for transparency
A Sandy Hill community group is also demanding more transparency before the program expands.
"The problems are so big and the lack of transparency is disconcerting at best. I find it very scary," said Calla Barnett, vice-president of Action Sandy Hill.
"These people are not being transparent. They are hiding."
Barnett said she's had a totally different experience with another Safer Supply Ottawa partner, the Sandy Hill Community Health Centre, which she feels has responded to community concerns.
It still sits on a liaison committee meant to promote collaboration with the community. Recovery Care withdrew from that same committee last month.
In an email, it cited "current health human resource challenges." But in an interview with CBC, Sarrazin gave a different reason.
"It got to a point where we felt that we were targeted, unfairly and unequally," she said. "It didn't feel like a comfortable space to be in."
Can safer supply change?
Aside from transparency, what do the critics want? They've increasingly converged on a single proposal: supervision.
Safer Supply Ottawa patients are generally allowed to take "carries," take-away doses of their medication for use away from the clinic.
Ottawa police officers say they're constantly seeing those pills on the street.
"You have street-level traffickers extorting clients and users of safer supply, robbing them of their medication, buying it from them or the clients themselves trading it for stronger substances," said Const. Paul Stam.
"We need to find a way to mitigate this diversion issue," Stam added. "One way would be to have those substances consumed on site in a supervised way."
Plante said that proposal "makes straightforward sense." Chris Greenshields of the Vanier Community Association is inclined to agree.
"What we're concerned about is the diversion, and the presence on the street," he said. "My own view is that certainly would argue for conditions in programming, for the witnessing of the use of the medication."
Supervised use 'complicated'
Defenders of the program say that's neither necessary nor practical. Sarrazin said it ignores the risks patients face as they progress in the program.
"What happens for the individual who has success on safer supply and needs to get away from the downtown core? You know, their pimp is beating them up every time they show up or they're being confronted by a dealer," she said.
"So while it makes sense when you first hear it, you think that's the solution, it gets really complicated as you start to unpack it."
Boyd said patients dose so frequently — every hour or two all day — that forcing them to use on-site whenever they need to is not realistic
Thomas Kerr, head of the division of social medicine at the University of British Columbia and director of research with the British Columbia Centre on Substance Use, said a policy against carries could drive people away from the program and back into the illicit fentanyl market — at the risk of their lives.
Wickens said he takes about eight Dilaudid pills at a time four times a day: morning, noon, evening and night. He said it would be a pain to come to the pharmacy that often.
He said the trip would be worthwhile for a stronger opioid like heroin, which has been tried as a treatment in B.C. and Switzerland.
In Wickens's opinion, it wouldn't be necessary to dose so often on a heroin-based program. That would make supervision more workable, he said.
The good and the bad
Overall, Wickens sums up his experience on the program like this: "I would say safe supply is good, and it's bad."
He seems to change his judgment from one sentence to the next.
"It's a crutch, but no, it's helping me get cleaner, at least I'm not smoking dirty drugs off the streets," he said. "I'm taking this medication as prescribed, but honestly, yeah, it is making it harder for me to get sober."
He said it makes him less likely to commit crimes, since he isn't always chasing cash to get high.
But he'd rather be sober and is thinking seriously about treatment.
But then again…
"If I were in the power to shut it down, I would not," he added. "I would not shut it down."
Health Canada said funding proposals must "identify risks as well as prevention and mitigation strategies" and that it "will continue to monitor and assess the best and most credible evidence when assessing the new round of SUAP applications."
In its response to Coun. Plante, Health Canada added that Pathways to Recovery has "a range of measures in place, including patient screening and monitoring, matching drugs to patient tolerance, and witnessed dosing based on individual client risk."
"Health Canada will continue to evaluate all available and emerging evidence in regards to prescribed alternatives programs to understand the potential benefits and risks, including the potential for diversion."
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