Heroin is a highly addictive illicit opioid that’s associated with a host of short-and long-term effects, including digestive problems, severe itching, impaired mental function and slowed breathing, which can result in coma or lasting brain damage. Heroin-related deaths have been on the rise in recent years, resulting in over 14,000 deaths in the United States in 2019 alone.
Canada is seeing a similar uptick in overdose-related deaths. Like the United States, the country has taken steps to reduce fatalities, including setting up supervised consumption and overdose prevention sites where individuals can use pre-obtained drugs under the safety and supervision of trained personnel. The country has also put more resources into naloxone distribution, which can save the lives of those who may otherwise die from an overdose.
Along with these measures, certain communities such as Toronto and Ottawa have taken an unconventional approach to reduce heroin-related deaths: distributing heroin from a “safe supply.” In other words, some local governments are handing out prescription-style bags of heroin to individuals living in addiction.
Unsurprisingly, this move has raised a few eyebrows and sparked conversations on the most effective ways to treat drug abuse and promote better outcomes for those living with addiction.
What Is “Safe Supply?”
Safe supply is an approach that focuses on saving the lives of those addicted to heroin, not by discouraging use but by helping users obtain drugs without the danger of purchasing contaminated drugs. Drugs, including heroin, that are generally only available through the illicit drug market are distributed through legal, regulated channels. What the individual receives is pharmaceutical grade heroin— no opioid-agonist treatments such as methadone or buprenorphine or slow-release oral morphine are distributed through this method.
Through this approach, individuals are prescribed the recreational drug to take home. They may receive a day’s or up to a week’s supply of tablets at one time. Once their supply is used up, they can return to the clinic for more. While they’re encouraged to take their pills at a supervised consumption site, this isn’t a requirement for the program.
Why Are Communities Utilizing This Approach?
This unconventional and highly controversial approach makes pharmaceutical-grade heroin available to those living with addiction, at a time when people are dying from drug overdoses at an unprecedented rate. Between January 2016 and June 2020, Canada lost more than 17,600 residents to overdose. Many of those overdoses involved heroin mixed with other more potent drugs such as fentanyl.
In fact, a big problem behind the opioid crisis is that the illicit drugs obtained illegally are often toxic, and their strength is unpredictable. Why? In response to efforts to prohibit the production, transport, sales and possession of illicit drugs like heroin, those who produce these drugs try to make their product as discreet and concentrated as possible. This makes it easier to transport large volumes of drugs, cutting down on total costs and increasing profits.
The end result is a drug that is entirely unpredictable—the individual using the substance has no way of knowing how concentrated the pill is and how much they can take without posing an immediate danger to their life.
The safe supply concept ensures that at least the individual receives a regulated dose of a drug. This doesn’t mean that the drug is safe, but it does eliminate the risk of the individual getting an extremely concentrated substance.
Safe supply isn’t a treatment method. It seeks to reduce harms caused by illegally produced drugs, but the drug the individual receives is the actual product with all of the same mind-and body-altering effects. Meanwhile, individuals aren’t required to take the drug under the supervision of a trained professional, although they’re encouraged to do so.
Proponents of safe supply believe that this may be a viable option for individuals who don’t want to pursue addiction treatment or substitution treatments, as well as those who want to continue using recreational drugs along with substitution treatment.
Common Criticisms of Safe Supply
Ensuring that those using heroin have access to comparatively safe prescription-grade drugs as an alternative to unregulated drugs may seem like a reasonable strategy for reducing deaths. There are, however, many good reasons to be skeptical about this approach, which has more than its fair share of critics.
Critics of this approach often note that prescribing dangerous substances such as heroin may simply enable continued drug use. Many believe that harm reduction methods should serve as stepping stones that help individuals obtain treatment and recovery from addiction. For example, supervised consumption sites should provide judgment-free supervision but also have materials available to help those ready to seek professional help.
The efficacy of the philosophy is also somewhat questionable. One study concluded that safe supply had no statistically significant impact on opioid-related deaths or the individual’s dependence on drugs obtained illegally.
Ultimately, many healthcare professionals believe that validating and even enforcing an individual’s addiction by sending them home with harmful recreational drugs prevents them from meaningfully taking control of their own lives. While many activists are in favor of decriminalizing drug use, they believe that the other extreme—state-sponsored drug use—is no less damaging to the individual.
For a more effective, compassionate approach, many look to Portugal, a country with its own history of opioid deaths. Instead of harm reduction methods, Portugal decriminalized the possession of small amounts of substances and poured resources into improving drug treatment options. Those using drugs weren’t sent to jail but were ordered to appear before a panel made up of an addiction counselor, a doctor and a lawyer. Individuals were directed towards effective treatment and recovery programs. In just 10 years, the number of those in addiction rehab more than quadrupled.
Seeking Treatment for Heroin Use
While it may be worthwhile for communities to seek ways to reduce the harmful effects of illicit and illegally obtained drugs, ultimately, the goal for those using heroin should be rehabilitation, abstinence and social reintegration. Effective treatment that offers hope for the future while helping the individual establish healthy habits and constructive coping mechanisms has far more value than simply working to reduce the harmful effects of addiction.
Those living with addiction deserve to be treated with the utmost compassion, dignity and respect. Addiction is nearly impossible to overcome alone, but with professional help, many can pursue recovery.
For those living with an addiction to heroin or other illicit drugs, addiction specialists provide compassionate, judgment-free help. To learn more about FHE’s programs for those living with addiction, call us today at (844) 913-1547.
