Five things to know about safer supply

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Yesterday, the 360 Degree Nurse Practitioner-Led Clinic (360 Clinic) released two reports about the federally funded safer supply program the clinic operates in downtown Peterborough. The reports present findings from researchers who have been evaluating the program since it started prescribing pharmaceutical opioids to people who use fentanyl two years ago.

The idea behind safer supply is to give people who use drugs a safer and medically supervised alternative to the often deadly supply of drugs currently available on the street. The practice has become controversial in recent years, as critics allege safer supply programs are making the opioid crisis worse.

I wrote an in-depth story about the 360 Clinic’s program, including the results researchers have observed among participants. In this newsletter, I’ll share a summary of what I learned.

Also in this week’s newsletter: The answers community members gave when the public library asked them, “What’s missing from Peterborough?”

Let’s get to it.

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Five things I learned recently about safer supply

 I knew the basic facts about safer supply when I started writing my new story about the pilot project in downtown Peterborough. But by talking to community members and reading some research, I learned so much more. Here are five things I learned about safer supply while writing the story.

The drugs are commonplace in Canadian healthcare.

The opioids people receive through safer supply are much less potent than street-sourced fentanyl, and they’re commonplace in the Canadian health care system. 

The prescriptions are for a drug called hydromorphone, which is also known by its brand name, Dilaudid, and a slang term, “Dillies.” Hydromorphone is often prescribed as a painkiller, including to people recovering from surgery or experiencing pain caused by cancer. The Peterborough hospital prescribed 621 doses of Dilaudid to outpatients in April 2024.

The federal government doesn’t control safer supply prescriptions — and it doesn’t directly pay for the drugs, either.

Most of the criticism against safer supply has been directed toward the federal government, which has funded 28 safer supply pilots across the country.

But these pilots don’t directly pay for the drugs — at least not in Ontario, where a provincial drug plan covers the cost for people on social assistance.

Health care is primarily provincial jurisdiction. And in Ontario, any physician or nurse practitioner can prescribe Dilaudid to treat opioid use disorder, according to the nurse practitioner at the 360 Clinic. In fact, there are currently two clinics offering safer supply prescriptions in Peterborough without federal funding.

But one thing that’s unique about a safer supply prescription is the size of a dose. People who have built up an opioid tolerance using super-potent fentanyl need a lot of Dilaudid pills — sometimes more than two dozen per day — to help stave off withdrawal.

Participants lives are stabilizing and improving, according to researchers

According to the new research, participants in the 360 Clinic’s program have experienced a significant reduction in overdoses. They’re also using fentanyl less, with 43 percent of participants saying they’d stopped using fentanyl altogether after a year in the program.

There have been other benefits, the reports state. Participants say they’re engaging in criminal activity less, because they don’t need to buy drugs. Two participants said they’ve been able to stop participating in survival sex work. And others are pursuing new life goals such as accessing housing, reconnecting with family, or looking for employment, according to program manager Carolyn King.

Trying to obtain street-sourced drugs “is a 24-hour job,” King said. So a safer supply prescription “gives people that ability to start tending to other parts of their life,” she said.

Diversion happens. Advocates say it’s not as big a problem as opponents claim.

Critics of safer supply programs often focus on the problem of diversion, which is when someone sells or shares their prescription drugs instead of using them as intended. Diversion happens. Four participants of the 360 Clinic’s program said they’ve shared their drugs with friends, according to this peer-reviewed study.

But supporters of safer supply say there’s no evidence that diversion is a widespread problem. Peterborough’s police chief said “we lack sufficient data to draw any concrete conclusions” about diversion of safer supply drugs.

And there are many potential sources of diverted opioids in Ontario besides safer supply. Peterborough’s medical officer of health, Thomas Piggott, estimated that less than 5 percent of opioid prescriptions in the province come from a safer supply program, leading him to conclude that “the likelihood that safer supply programs are a primary source of diversion is very, very low.”

Understanding the history of the opioid crisis matters.

The opioid crisis is worse than ever in Peterborough. But Piggott said that’s not because significantly more people are using drugs. It’s because the drugs people are using have become more toxic.

In the 80s and 90s, pharmaceutical opioids were prescribed more liberally than they are today, Piggott explained. A lot of people developed a dependency on the drugs during those decades, and in response doctors cracked down on prescribing in the late 2000s and early 2010s. That proved disastrous for people who were already addicted or who needed opioids to manage pain. “Many people that were using a stable, safe supply of opioids … were pushed to the street,” Piggott said. Since then, street drugs have only become more unpredictable and deadly.

With this context in mind, researchers at the 360 Clinic have argued that safer supply can be understood as an effort to “re-prescribe” a safer supply of opioids to people who were cut off from them in the early 2010s.

Those were just short summaries of some of the things I learned while researching safer supply. Read my full article here.

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What’s missing from Peterborough? Community members share their answers at the public library.

Smiles. A good buffet. Safe housing for everyone. No more carbon taxes. A bus to Lindsay.

Those are just a few of the answers community members gave when the Peterborough Public Library asked, “What’s missing from Peterborough?”

In an initiative called Community Questions, the library is asking the community a different question each month from now until August. Answers are posted on sticky notes at the main branch. The “What’s missing?” question was asked in May. June’s question is: “What is one thing you wish you knew more about?” Pop by the library or connect on social media to share your answer.

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Other stories to watch

PICKLEBALL PUSHBACK CONTINUES

Ongoing protests against the city’s plan to build a 16-court pickleball facility in Bonnerworth Park continued Monday, when a large crowd that had gathered outside city hall demanded Mayor Jeff Leal come out and face them. Councillors Joy Lachica, Keith Riel and Alex Bierk all stepped outside to show their support for the protestors during a break in Monday’s council meeting, which prompted the crowd to start chanting “where’s Jeff?,” according to Global News. Leal later told reporters he could not come out because he was “occupied in being the presiding officer of the meeting.”

Trustees with the local Catholic school board are also raising concerns about the redevelopment, which will see much of Bonnerworth Park paved over to build the pickleball courts, as well as a second parking lot, an expanded skate park and a bike pump track. According to the Peterborough Examiner, trustees are worried the changes could hamstring the athletics program at St. Peter’s Catholic Secondary School, which uses Bonnerworth Park.

APARTMENT PROPOSAL APPROVED

A proposal for a 7-storey, 76-unit apartment building on Armour Road, which faced opposition from neighbours in 2020, now has the greenlight from city council to move forward. The design features parking in front of the building, something that goes against Peterborough’s new official plan. The plan calls for parking to be hidden behind buildings, to create a “high quality appearance.” But council voted on Monday to allow the apartment complex to be built with parking in front, since the development was first proposed in 2019, before the new rules around the location of parking were brought in.

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