In 2005, Mischley became one of the first people in his Michigan county to be prescribed buprenorphine for OUD. Buprenorphine has been a Food and Drug Administration-approved pain medication since the 1980s, but was only approved as a medication for opioid use disorder (MOUD) in 2002. Tighter regulations wouldn’t arrive until later, and Mischley’s initial prescription was for 64 mg—a dose that would be unheard of today. 

Mischley was on his mom’s health insurance plan, which was a good one because she had a government job with the United States Postal Service. Even that didn’t cover the entire prescription, leaving him with $200 or $300 in out-of-pocket costs each month.

“I told them that was too much, the cost was too much,” he said. “Everything was too much.”

But within a year his prescription was dropped to 32 mg, and things got easier for a little while.

Buprenorphine is a partial opioid agonist. It doesn’t affect people as strongly as full agonists such as methadone, which has been an FDA-approved MOUD for over 50 years, or unregulated opioids like heroin and fentanyl. Buprenorphine dulls the effects of full agonists, but on its own it can be enough to keep withdrawal at bay, which is all many OUD patients are looking for. And unlike methadone, which can only be dispensed at a clinic, buprenorphine can be picked up at a pharmacy like any other prescription. 

Mischley still had access to street-supply opioids that more readily produced a high, and found this challenging since he wanted to avoid them. But with a 32-mg buprenorphine prescription he managed to make things work by waking at the crack of dawn, taking two of his four daily pills and then falling back asleep. By the time he woke up again to actually start his day, the medication would have kicked in and would make other opioids feel like nothing if he took them. Which he found helpful.

“If I went and shot heroin after using Suboxone, it wouldn’t do anything,” he said. “It would just be like injecting water.”

The two MOUD tablets that the FDA approved in 2002 were Subutex, the brand name for buprenorphine, and Suboxone, which contains both buprenorphine and a smaller amount of naloxone. The Substance Abuse and Mental Health Services Administration (SAMHSA) endorsed the new MOUD up to 32 mg per day, which clinical evidence strongly supported as the maximum dose. The FDA, however, sent them onto the market with the following labeling:

The recommended target dose of SUBOXONE is 16 mg/day. Clinical studies have shown that 16mg of SUBUTEX or SUBOXONE is a clinically effective dose compared with placebo and indicate that doses as low as 12 mg may be effective in some patients. The dosage of SUBOXONE should be progressively adjusted in increments / decrements of 2 mg or 4 mg to а level that holds the patient in treatment and suppresses opioid withdrawal effects. This is likely to be in the range of 4 mg to 24 mg per day depending on the individual.

Over the next two decades, the impact of this would be that insurers generally won’t cover anything higher than 24 mg, and most prescribers won’t push them because they won’t consider higher doses in the first place.

But for many OUD patients, higher doses are what make buprenorphine effective.

Buprenorphine prescriptions above 24 mg have been linked to higher treatment retention, including in the period immediately after initiation. They’ve also been linked to a 50-percent reduction in emergency department visits and inpatient care. And over the past decade as fentanyl has taken the place of heroin in the unregulated drug supply, opioid tolerances are increasing and more people are finding that a maximum dose of 16 mg or 24 mg isn’t enough to keep them well. 

Centers for Disease Control and Prevention data for 2023

For those patients, the options for avoiding withdrawal are generally street-supply opioids, or methadone.

Health care providers who prescribe opioids for pain management use a framework called morphine milligram equivalents, or MME, to calculate what a patient’s dose for one opioid would correspond to for a different opioid. This doesn’t apply to MOUD, for a laundry list of pharmacological reasons starting with the fact that buprenorphine is a partial agonist and methadone is a full agonist; it’s a little like comparing apples to oranges. There is no universal equation that can say exactly what 24 mg or 32 mg of buprenorphine translates to in methadone. But for anyone taking more than 8 mg buprenorphine, standard practice would be to make the switch by abstaining for 24 hours, then starting with 30 mg methadone and going up from there.

Both methadone and buprenorphine are invaluable MOUD, but they are very different. Not everyone wants to go from a partial agonist to a full agonist, and vice versa. But the biggest reason someone struggling on a high dose of buprenorphine wouldn’t want to switch to methadone isn’t because of the medication itself, but because of the clinic system. Getting methadone for OUD usually means reporting to an opioid treatment program at dawn daily. Everything else in life—work, travel, illness—has to fit around that. Add to that the heavy surveillance, lack of privacy, long commutes for people in rural areas and notoriously punitive clinic culture, and it’s clear why for many people the biggest advantage of buprenorphine is that it can be discreetly picked up once a month at a pharmacy. 

Capping medication at a dose that doesn’t provide adequate relief is what pushes many patients to street supply, which is more dangerous than pharmaceuticals but easier and often more dignified to access. Research on extended-release injectable buprenorphine suggests that for people who inject opioids, doses higher than 32 mg could result in less use of street supply—if insurance weren’t a barrier.

In 2010 the FDA doubled down following its approval of Suboxone film (which has become the more recognizable formulation, compared to the tablets) stating that doses higher than 24 mg “have not been demonstrated to provide any clinical advantage.”

As part of the approval process, manufacturer Reckitt Benckiser Pharmaceuticals Inc stated that anything above 16 mg should be considered an exception.

“[T]here should be little difference in clinical effectiveness at doses between 16 mg and 24 mg in most patients,” Reckitt Benckiser advised. “When a patient expresses a need for a higher dose, consider the possible causes [and first] explore other alternatives. Also consider the possibility that the patient may be exaggerating symptoms to obtain additional medication for diversion.”

There has been no watershed moment for access to doses above 24 mg or even 16 mg—but there has been some progress.

Pre-pandemic data show that only around 3 percent of buprenorphine prescriptions were for doses above 24 mg, and only around 4 percent of prescribers were writing them.

“A lot of physicians and nurse practitioners have been afraid to write [prescriptions] for higher doses,” Dr. Edwin Chapman, an internal and addiction medicine specialist who has been treating OUD patients for 25 years, told Filter. “In their training, they were told for years that 16 mg was the target dose, 24 mg in special cases.” 

Patients and providers have been advocating for years to remove the additional layers of bureaucracy and surveillance that come with prescribing buprenorphine for OUD, like urine drug screens and extra steps required for insurance approval. In 2023, the Drug Enforcement Administration eliminated the X-waiver, a federal requirement that had been created specifically for buprenorphine and had severely restricted access to prescriptions. Telehealth prescribing has also now been expanded, building on momentum that began during the COVID-19 pandemic. There has been no watershed moment for access to doses above 24 mg or even 16 mg—but there has been some progress.

In 2023, Chapman and dozens of other stakeholders presented the FDA with their case for doses over 24 mg having benefits for many patients, at no added risk. The concept gained traction with federal agencies, and in December 2024 the FDA made a public recommendation that manufacturers of buprenorphine products that dissolve under the tongue (meaning tablets or film, but not the longer-acting injectable formulations) update their labeling.

“[N]either 16 mg/day nor 24 mg/day should be interpreted as maximum dosages,” the FDA stated.

The agency advised removing references to a “target dose,” and noting that doses above 24 mg “have not been investigated in randomized clinical trials but may be appropriate for some patients.”

In a letter explaining the decision to prescribers, Dr. Marta Sokolowska of the FDA’s Center for Drug Evaluation and Research noted that the agency was aware that insurers had been restricting access to higher doses as a consequence of the language previously used on the labeling.

In 2023, one of Chapman’s patients overdosed after United Healthcare capped his buprenorphine coverage at 24 mg. The patient survived—and the story made the front page of the Washington Post. Since then, United has covered Chapman’s patients up to 32 mg without issue. But he still has to go through the process of obtaining prior authorizations. And months after the FDA formally clarified that buprenorphine has no maximum dosage restrictions, this hasn’t changed. 

“8-2MG” refers to a standard Suboxone strip containing 8 mg buprenorphine combined with 2 mg naloxone. Insurers will often cover prescriptions up to three strips (24 mg buprenorphine) per day, but not four.  

“I don’t know if it’s just because of me or whether other doctors have difficulty getting above 24 mg with United Healthcare,” Chapman said. “But the point is they’re still saying 24 mg [is the limit].”

Like every other extra bureaucratic hurdle attached to buprenorphine, prior authorizations are associated with decreases in treatment retention.

The American Medical Association, one of the organizations that pushed the FDA to revise its labeling recommendation, has urged insurers to update their policies accordingly. The FDA is also currently supporting a high-dose buprenorphine study in collaboration with the Department of Veterans Affairs. But experts reached by Filter say it could be a year or more before the FDA recommendations begin to have real-world impact for most patients. Meanwhile, many will lose access amid the arrival of President Donald Trump’s “big, beautiful law” and its $1 trillion in cuts to Medicaid. Of the nearly 2.5 million people in the United States who filled buprenorphine prescriptions between April 2020 and March 2024, approximately 48 percent used Medicaid to do so at least once.

Elimination of the X-waiver has not yet done much to actually increase the number of health care providers prescribing buprenorphine. And, despite the updated labeling recommendations and the removal of the X-waiver, some states also maintain their own restrictions that impede access. 

“I’ve had people tell me not even to send the second prescription because they know they can’t afford it this month.”

Dr. Jared Matthews, an addiction medicine physician in Tennessee, described the state as “a really great example of what not to do.”

Tennessee has taken some recent steps to increase access to 24 mg doses of buprenorphine, but in practice the state effectively caps prescriptions at 16 mg.

“Administrators with the actual Medicaid program, most of their higher-level executives are physicians,” Matthews told Filter. “They are well aware of what the medical evidence tells them they should be doing … yet when they take these proposals to their political leadership, the answer is always No.” 

So for patients who require a higher dose, Matthews writes two separate prescriptions: one for a 16 mg dose covered by Medicaid, and one for whatever remaining number of milligrams the patient needs, which they must pay for out of pocket. Each additional 8 mg can cost upwards of $200 per month.

“I probably have no less than 100 patients where 16 milligrams is not adequate to control the signs and symptoms of their opioid use disorder,” Matthews said. “I’ve had people tell me not even to send the second prescription because they know they can’t afford it this month.”

In Kentucky, prescribing over 16 mg is restricted to advanced practice registered nurses certified in addiction medicine. The state also doesn’t allow buprenorphine to be prescribed for pain management, only OUD.

“Indiana allows it for pain management,” Dr. James Murphy, whose clinic straddles the border between the two states, told Filter. “Federally, it’s allowed. The Veterans’ Affairs nationally actually has Suboxone listed as one of the choices that we can use for chronic pain management. Yet in Kentucky that would be considered illegal.”

Murphy treats some pain patients with buprenorphine, or with methadone; many have complex needs wherein OUD and chronic pain overlap. As a result of the outdated regulations, he fields a lot of calls from pharmacies and insurers alleging that his patients’ doses are too high. But for his patients across the river in Indiana, he’s able to more readily prescribe the doses they need.

“What is it about a river or a line or a border that makes the patient different?” Murphy asked. “The patient with chronic pain and opioid use disorder is the same in Kentucky as [in] Indiana.”

“Red flags” are triggered by activity the DEA considers suspicious.

Buprenorphine is regulated under Schedule III of the Controlled Substances Act. As with other opioid analgesics, and certain other pharmaceuticals like benzodiazepines, buprenorphine prescriptions are tracked by the DEA through a nebulous web of proprietary algorithms known as prescription drug monitoring programs (PDMP). “Red flags” are triggered by activity the DEA considers suspicious.

Providers, for example, can trigger red flags by writing a lot of prescriptions for higher doses. Pharmacists are required to check for these red flags, and can be held liable for filling prescriptions the DEA determines they shouldn’t have. 

Patients, meanwhile, can get red-flagged by paying for prescriptions in cash—which data suggest is the most common method of payment for buprenorphine prescriptions above 24 mg.

“Sometimes it’s difficult for patients to even fill a buprenorphine script,” said Jonathan Larsen, a public health law expert at Temple University. “If a pharmacist is feeling uncomfortable about [dispensing] buprenorphine because it might raise red flags.”

A secret shopper study conducted in 2022 found that in Tennessee, the majority of pharmacies would likely refuse someone trying to start treatment with buprenorphine. Researchers called 183 pharmacies, across all but one of the state’s 95 counties, asking to fill a prescription for a new patient—and 53 percent of the pharmacies said No. Many had caps on the number of buprenorphine patients they were allowed to serve, as well as waiting lists for when space opened up. Many pharmacies didn’t stock buprenorphine at all, citing pharmacist discretion as one of the main reasons.

Murphy has written prescriptions that patients were unable to pick up because pharmacists refused to fill them. This is a widespread barrier. Fear of being raided and shut down keeps many pharmacists from filling higher-dose buprenorphine prescriptions, even if the insurer has agreed to cover it.

One doctor stopped seeing Mischley after a urine drug screen indicated he’d used marijuana.

These days, Mischley’s prescription is for 24 mg and that’s been working well for him. But over the past two decades, heavy surveillance and aura of illegality around higher-dose buprenorphine has cut off access to his prescription multiple times.

One doctor stopped seeing him after a urine drug screen indicated he’d used marijuana. This was before both medical and adult-use legalization in Michigan, but this didn’t seem to be where the concern was coming from.

“[The doctor] said since his license was federal,” Mischley said, “and [marijuana was] illegal federally, he couldn’t risk that.”

Around 2012, the doctor prescribing Mischley’s buprenorphine by that time was investigated by the DEA, and his practice subsequently shut down. This doctor also issued medical marijuana cards, and apparently the DEA felt he issued too many of them.

Mischley is on his seventh provider. Like paying in cash, frequently changing doctors can be a DEA red flag, too.

Top image (cropped) via Drug Enforcement Administration. First inset graphic via Centers for Disease Control and Prevention. Second and third inset graphics via Dr. Edwin Chapman.

R Street Institute supported the production of this article through a restricted grant to The Influence Foundation, which operates Filter. Filter‘s Editorial Independence Policy applies.

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In November 2024, Dr. Jess Wilder cofounded Doctors for Safer Drug Policy (DSDP), whose members ran a week-long unsanctioned OPS outside Nanaimo Regional General. A simultaneous pop-up OPS ran outside a hospital in Victoria. DSDP has since inspired health care workers at hospitals across Canada to plan similar initiatives.

Wilder was the harm reduction and education physician lead at Island Health, as well as the lead for Nanaimo Regional General’s addictions medicine consult service. On January 22, Island Health placed Wilder on administrative leave pending an investigation. The health authority did not respond to Filter’s request for comment.

“At the time, they refused to provide concrete examples of their concerns when directly asked,” Wilder told Filter. “Two weeks later, and there has been ongoing radio silence from Addiction Medicine Substance Use [department] leadership with regards to these concerns.”

She resigned from her positions February 5. Filter was the first outlet to speak with Wilder in the aftermath of the decision.

“For too long, physicians have been shamefully silent on these matters.”

“I worry that you will erode the trust we have built in our communities,” Wilder wrote to her employers, in a resignation letter reviewed by Filter. “I worry that this will be seen by our patients and allies as a turning away from them in a time of need.”

Dr. Kelsey Roden, a DSDP member based in Victoria, resigned from her position as Island Health’s South Island Addiction Medicine lead on the same day in solidarity with her colleague.

“I just don’t feel comfortable acting in a leadership role within a department that is conducting themselves that way,” Roden told Filter. “The physicians that I have spoken with have been upset that someone who was a harm reduction lead within Island Health is experiencing punitive measures, just for her work that she was doing in advocating for hospital-based OPS … there just seems to be a discrepancy.”

Roden will return to working at community clinics where she practiced before her leadership role with Island Health. Both she and Wilder said they intend to continue working in the medical field providing care for people who use drugs, as well as continue their advocacy with DSDP.

“For too long, physicians have been shamefully silent on these matters,” Wilder wrote in her resignation letter. “We owe it to our patients to speak up—loudly, when necessary—for the tools and policies needed to help keep them safe.”

“The citizens of British Columbia deserve more of what Dr. Wilder and others are doing to save lives, not less.”

In November, when DSDP launched its first two OPS in Victoria and Nanaimo, Island Health Chief Medical Health Officer Dr. Réka Gustafson stated that unsanctioned sites will not be permitted on hospital grounds.

“This position is not meant to dissuade advocacy but rather to ensure that all services provided on Island Health property adhere to regulatory, safety, and clinical standards,” Gustafson said at that time.

At least a dozen organizations and individuals including Moms Stop the Harm, Vancouver Island University’s Harm Reduction Alliance, Surrey Union of Drug Users, Police Oversight With Evidence and Research and the Harm Reduction Nurses Association have sent letters of complaint to Island Health, expressing their solidarity with Wilder and denouncing her forced resignation. 

“History will view the acts of Dr. Wilder as heroic, while your actions only serve to perpetuate more harm and death,” Moms Stop the Harm Executive Director J. Steward wrote to Island Health. “The citizens of British Columbia deserve more of what Dr. Wilder and others are doing to save lives, not less.”

Image of Nanaimo Regional General Hospital via Rural Coordination Centre of BC

The post BC Doctor Who Organized Pop-Up OPS Resigns Following Retaliation appeared first on Filter.

On February 3, Trudeau posted on social media that he’d “just had a good call” with Trump. In addition to implementation of the border plan, he announced the creation of a “fentanyl czar;” a ”Canada-US Joint Strike Force” with a focus on fentanyl interdiction; and a move to classify transnational drug-trafficking organizations as terrorists, as the Trump administration is doing.

While the United States has a “drug czar”—the colloquial title for director of the Office of National Drug Control Policy, a position which since 2021 has been occupied by Dr. Rahul Gupta—Canada has not previously had any “czar” in its drug policy. According to Public Safety Canada, the fentanyl czar “will engage with US counterparts, and enhance operational collaboration and efficiency in combatting fentanyl, in order to enhance law enforcement tools to combat organized crime in Canada.” But most details are still unclear.

The four pillars of the Canadian Drugs and Substances Strategy are “prevention and education;” “substance use services and supports,” which encompasses harm reduction, treatment and recovery; “evidence;” and “substance controls,” which includes regulation and law enforcement, and the country’s Controlled Drugs and Substances Act.

To understand the potential impact of Trudeau’s announcement, Filter spoke with Nicholas Boyce, policy director at the Canadian Drug Policy Coalition. Boyce is also a member of the Canadian Civil Society Working Group on United Nations Drug Policy, and a consultant for the Canadian government on the UN Commission on Narcotic Drugs. Our interview has been edited for length and clarity.

I just had a good call with President Trump. Canada is implementing our $1.3 billion border plan — reinforcing the border with new choppers, technology and personnel, enhanced coordination with our American partners, and increased resources to stop the flow of fentanyl. Nearly…

— Justin Trudeau (@JustinTrudeau) February 3, 2025

Brishti Basu: The December announcement involved allocating $1.3 billion to new canine teams, a new drug-profiling center, a Precursor Risk Management Unit and funding for Royal Canadian Mounted Police helicopters, drones and surveillance towers. Is any of this an effective method for addressing Canada’s overdose crisis and unregulated drug supply?

Nicholas Boyce: This is all supply-side intervention. It does nothing to address the demand for drugs and why people want drugs or use drugs or need drugs. 

Until we address that, there’s always going to be a market for drugs, and we have shown time and time again, over the decades, that drug suppliers and producers and traffickers find ways to innovate to meet that demand. 

We have not significantly reduced the supply of drugs because people want them. Every dollar that we are spending on so-called border security and police and law enforcement is a dollar we are not spending on addressing the housing crisis, mental health or employment programs. Those are the things that actually would reduce the demand for drugs and actually might impact the supply of drugs … this is just an incredible waste of resources.

This is a ramping up of the status quo. Right now we are ramping up the war on drugs, which is actually a war on people who use drugs. 

We are scapegoating drugs, and right now the drug of the day is fentanyl. We’re using that as a scapegoat and not talking about real issues such as housing, people’s well-being, environmental and climate justice [and the] racist, colonial and classist roots of drug policy. 

“Fentanyl is not the issue. There’s nothing inherently dangerous about fentanyl.”

BB: What exactly is a “fentanyl czar”? Do we know anything yet about the government’s plans to hire or appoint this person?

NB: I have absolutely no idea … I don’t know that they even know [those details]. I feel like this was something that was thrust on them. It probably was never part of the original $1.3 billion. 

It’s smoke and mirrors, and optics to make it look like you’re taking something seriously. But really we don’t need a “fentanyl czar.” We need a drug policy czar to actually critically appraise drug policy in Canada and internationally.

Fentanyl is not the issue. People receive prescription fentanyl every day in hospitals. There’s nothing inherently dangerous about fentanyl. 

What makes it dangerous is [when it’s] unregulated. Fentanyl in Canada [increasingly] has benzodiazepines in it; are we going to have a “benzodiazepine czar” next year? It’s just ridiculous.

“We’re seeing increasingly calls for involuntary treatment. We don’t even have access to good voluntary treatment.”

BB: Does this announcement coincide with any kind of federal expansion of harm reduction or treatment services?

NB: No … I did question Health Canada and got a response that this new announcement of $1.3 billion is on top of the [existing funding for the] Canadian Drugs and Substance Strategy. But I haven’t seen anything new in terms of major announcements on treatment and harm reduction.

We’re seeing increasingly calls for involuntary treatment. We don’t even have access to good voluntary treatment right now, so why are we even talking about involuntary treatment?

The Ontario government is replacing [safe consumption sites] with these Homeless Addiction Recovery and Treatment hubs that supposedly will provide a little bit more housing. But if you look at the number of units they are actually providing, it’s, I think, about 6 percent of what’s actually needed in the province. At the same time any program that is applying for those is prohibited from handing out sterile drug-use equipment, so we’re going to see spikes in HIV and hep C rates as a result of that.

BB: How much of the US drug supply actually comes from Canada, to warrant such a heavy response?

NB: A lot of the previous drug enforcement and interdiction efforts may have [reduced] the flow of fentanyl into Canada, but have only created domestic production. And we are now a known exporter of fentanyl. 

I wouldn’t be surprised that once you stop the flow from Canada and Mexico, you’re going to see [increased] domestic production in the States, if it’s not already happening.

We’re always playing a game of Whack-a-Mole with the supply side … It’s not working, and it’s actually causing many of the problems.”

BB: What does the current street supply of fentanyl look like in Canada, and what impact can we expect these measures will have?

NB: We’re just going to continue seeing an evolution. We had opium, and then we cracked down on that … heroin, and we cracked down on that. We remember the days of oxycodone, and then we cracked down on that.

Then you see the shift to synthetic opioids, such as fentanyl. And then [we started seeing] different types of fentanyl, like carfentanil. For a few years now, we’ve seen benzodiazepines added to the fentanyl supply. Now we’re starting to see veterinary tranquilizers and nitazenes.

We’re always playing a game of Whack-a-mole with the supply-side piece of the puzzle. It’s not working, and it’s actually causing many of the problems. Now you’re not only withdrawing from opioids, but you’re withdrawing from benzodiazepines, [which can be] actually even more dangerous. 

Methadone isn’t going to work with benzos. Also, people’s tolerances on fentanyl have become so high that … we’ve made treatment harder, we’ve made withdrawal harder, we’ve made overdose prevention harder.

We actually had this whole experience in the 1920s with alcohol prohibition, where we prohibited alcohol and instead of drinking beer, we moved to more toxic and concentrated moonshine. This is just history repeating itself.

Photograph of Donald Trump and Justin Trudeau, 2017, via Trump White House Archive/Flickr

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In a January statement announcing the expansion of “bed-based services,” the BC Ministry of Health projects serving up to 250 people across four sites in Kelowna, Nanaimo, Prince Rupert and Vancouver’s Downtown Eastside. Three of the four facilities did not respond to Filter’s inquiries about specifics of the treatment being offered. The health ministry told Filter that it anticipated people will stay an average of six months, but did not provide further details.

“Is it religious? Is it 12-step?” asked City of Vancouver drug policy consultant Karen Ward. “What’s the practitioner-to-client ratio, a basic question at the very benchmark across health systems? We have no idea.”

According to Karis Support Society in Kelowna, the facility that did respond to Filter‘s inquiry, a program coordinator and a support worker have been hired to oversee the six treatment beds but there is no medical staff on site.

“[T]he majority of our participants have either a family physician or go to the OAT Clinic or Urban Outreach,” a Karis Support Society spokesperson told Filter.

Patients are expected to stay between six months and two years. All six beds are currently occupied; the waitlist is generally from 30-60 days. The facility primarily offers services like meals, laundry, daily programming and access to counselors and community supports.

In the health ministry statement, the Karis Support Society beds are described as offering “tailored support for pregnant women and women with children to help reach their recovery goals.”

All six beds at in Nanaimo are “for women who have completed treatment.”

According to the health ministry statement, all six beds at Island Crisis Care Society in Nanaimo are “for women who have completed treatment to get longer-term support with their recovery.” Moms Stop the Harm member Correne Antrobus told Filter that the facility is not a substance-use treatment center.

Antrobus, whose daughter uses drugs, described trying to gain access to government-funded detox and treatment beds as “a battle every step of the way.” 

“I know it’s really difficult to navigate the system for even someone that’s housed,” she said. 

Harbor Lights Addiction Treatment Program in Vancouver has a publicly funded 12-bed program for “female-identifying adults (19+) women only.” It serves people who have already initiated and are stable on methadone, Methadose, Kadian or Suboxone, provided their dose is under a given threshold.

“People are expected to be abstinent from non-prescription substances for a minimum of 72 hours before intake,” the program states on its website. “People on a prescribed opiate replacement therapy are welcome in this program. During your intake, you’ll be asked when you last used, and asked to provide a urinalysis and breathalyser sample.”

Both BC’s New Democratic Party and its Conservative Party have ramped up support for involuntary treatment.

Since 2017, the year after BC declared the overdose crisis a public health emergency, the health ministry province reports opening 659 publicly funded treatment beds, for a total of 3,645. However, the Investigative Journalism Foundation found that more than one-third of the beds included in this number are simply lower-barrier shelter beds, which don’t necessarily turn away people who use drugs but do not provide any treatment services.

The alternatives are for-profit facilities like Surrey-Langley’s John Volken Academy, where patients have reportedly been forced to work up to 56 hours a week and banned from talking to patients of the opposite sex. One patient was allegedly gored by a water buffalo while working on a farm run by the company.

“I know lots of folks who … think, ‘I’ll stop on my own, I’ll just bare-knuckle it because I don’t want to go to [any] of those places,’” Ward said. 

Meanwhile, both BC’s New Democratic Party and its Conservative Party have ramped up support for involuntary treatment. The first beds in those new spaces are slated to open inside correctional facilities.

Between January and October 2024 BC recorded 1,925 overdose deaths, a decrease from the 2,107 deaths recorded for the same time period in 2023.

“What that [health ministry statement] told to me at least was, ‘We’re sticking with our messaging and framing … harm reduction keeps you alive until you can get a space into treatment,’” Ward said. “Which I just think is fucking appalling and so cynical because, good luck getting in.”

Image via Wikimedia Commons/Creative Commons 4.0

The post Nearly Half BC’s New “Substance-Use Treatment Beds” Provide No Treatment appeared first on Filter.

On January 20, a group of about seven health care workers and community advocates set up an OPC outside North Island Hospital Comox Valley on Vancouver Island. They join the growing ranks of Doctors for Safer Drug Policy (DSDP), which formed in November 2024 when members opened a short-term unsanctioned OPC in Victoria and another in Nanaimo.

Comox Valley pop-up organizer Dr. Eva Hemmerich told Filter that many of the hospital’s patients use drugs, and in order to avoid withdrawal every couple of hours—particularly with fentanyl—people were going to remote areas where they could use alone.

“They have to hide and [use] in a stairwell, in the bathroom, in the parking lot or on hospital grounds. And at times, they overdose and die,” Hemmerich said. “There have been people dying in the bathroom. Or in the forest. In the bushes. It’s unbelievable.”

Several days before the launch of the Comox Valley Hospital OPC, organizers received a letter, which has been reviewed by Filter, from Vancouver Island Health Authority’s director of legal services. 

“If Doctors for Safer Drug Policy or its members proceed with any unapproved clinical service or demonstration on Island Health property,” the letter states, “this would necessitate the involvement of our security services team and potentially the local police.”

The pop-up was met by about a dozen private security guards and Royal Canadian Mounted Police outside Comox Valley Hospital on the morning of January 20. Hemmerich characterized the response as “respectful and quietly supportive.” Similar to what unfolded at the Victoria and Nanaimo pop-ups in November, the OPC had to move a few feet from the original location so that it was technically off hospital grounds, and was otherwise permitted to operate. It had its first participant within a couple of hours. The group plans to operate 10 am to 6 pm through January 24.

“What is lacking right now [in Newfoundland] is understanding what people are using. There’s little to no research.”

Dr. Jessica Wilder, who cofounded Doctors for Safer Drug Policy and organized the pop-up OPC at Nanaimo, told Filter that health care workers and harm reduction advocates across Canada have reached out to DSDP to learn about how to replicate their model. The group has created a 36-page toolkit that outlines how hospital workers can organize pop-up OPC and what to expect, and has been sharing it widely.

“[It contains] as much information as we can possibly provide to make it as easy as possible for somebody to replicate these actions,” Wilder said. “And all the hard lessons that we learned throughout.”

DSDP also created a map of locations where it’s communicated with people about launching an OPC. Several are in the early planning stages and organizers did not wish to be interviewed out of concern for government reprisal.

On the East Coast, Newfoundland harm reductionist Luca Shaefer and a dozen other volunteers were already working on opening a pop-up OPC when they heard the call from DSDP.

“I was really just overjoyed to be a part of a simultaneous, coincidental call to action,” Shaefer told Filter. “We are thinking of having it near a hospital, near a place in St John’s Newfoundland called Long’s Hill.”

They’ve raised about $3,000 and plan to launch sometime in the next month. Schaefer also noted that compared to BC, there are less data available on the drug supply in Newfoundland.

“I feel like what is lacking right now is understanding what people are using. There’s little to no research,” she said. “I think St John’s is catching up in terms of applying and integrating harm reduction to a lot of outreach and frontline work here.” 

“What I find bizarre, in a way, is that Island Health believes as much in the need for [OPC] as we do.”

Hemmerich said that her patients who currently use drugs as well as her patients in recovery have expressed support for the Comox Valley Hospital pop-up. Not having to worry about going through withdrawal would make people less hesitant to go to the hospital in the first place. 

Hemmerich runs an opioid agonist therapy clinic and is the medical lead for AIDS Vancouver Island’s safe supply program, which prescribes pharmaceutical fentanyl to a small number of patients in the Comox Valley. A family doctor for most of her career, the overdose crisis pushed Hemmerich to switch to addiction medicine. More than 16,000 people have died of overdose in British Columbia since the crisis was declared a public health emergency in 2016.

“What I find bizarre, in a way, is that Island Health believes as much in the need for OPS as we do,” Hemmerich said. 

Leaked documents obtained by Filter show that in September 2023, provincial health authorities began drawing up plans to launch government-sanctioned OPC at three hospitals. The plan was dropped in April 2024.

“The [provincial] government is where the problem lies, and Island Health will do as the government dictates,” Hemmerich said. “The government has prioritized politics over addressing the toxic drug crisis.”

On January 21, BC’s new health minister, Josie Osborne, told Filter that plans are under way to finalize minimum service standards for OPC, but did not provide details about what those standards are nor who is finalizing them.

“This work is ongoing and I will provide an update as soon as I can,” Osborne said. “In the meantime, we are going to keep building and expanding mental health and addiction services so people can get the care they need, where and when they need it.” 

The statement provided to Filter also pointed to existing addiction services at hospitals in Victoria and Nanaimo. But Dr. Wilder, who works as the lead physician on the addictions medicine team at the Nanaimo’s Regional General Hospital, said those programs are insufficient, which is part of why the unsanctioned OPC opened to begin with.

Image (cropped) via Doctors for Safer Drug Policy/Google Maps

The post More Unsanctioned OPC to Pop Up Outside Hospitals Across Canada appeared first on Filter.

However, on November 19 and 20, Victoria Police Department (VicPD) officers told the volunteers to take the Victoria tent down, citing Canadian federal law that prohibits public use of unregulated drugs.

“It’s a federal law, you don’t have an exemption,” a VicPD officer could be heard saying in an audio recording shared with Filter. “You’re standing by, you’re erecting a shelter for them …  you’re party to an offense, to a certain degree.”

Volunteers kept the site running, but said that fewer people accessed it after the first day, which they attribute in part to the chilling effect of VicPD efforts.

VicPD spokesperson Griffen Hohl told Filter that while operating an unsanctioned overdose prevention center (OPC) is against the law, the department didn’t arrest or disperse anyone because the Canadian Charter of Rights and Freedoms, the equivalent document to the United States Bill of Rights, protects “their rights to gather peacefully and demonstrate.”

“These services ought to be provided by the employer.”

At the Nanaimo pop-up, the week played out differently. After officers helped move them off hospital ground and onto the sidewalk the first day, none appeared again.

In addition to OPC services, the Nanaimo site successfully diverted an emergency department visit by meeting someone on their way in and providing withdrawal management care in the tents. In another instance, a patient at the hospital visited the tent specifically for wound care.

Doctors for Safer Drug Policy organized the OPC in response to an overdose crisis that has recorded 16,721 deaths since it was first declared a public health emergency in 2016. It’s also a response to a political climate increasingly hostile toward people who use drugs, and more directly a response to recent complaints from nurses about patients smoking unregulated drugs inside hospitals.

“It is disturbing that doctors at Nanaimo Regional General Hospital and Royal Jubilee Hospital have had to resort to establishing [OPC],” the BC Nurses Union told Filter. “These services ought to be provided by the employer.”

The province had intended to open OPC at three different hospitals, but abandoned that decision, prompting the doctors’ response. Had the authorized OPC proceeded, they were slated to be operational by now.

Internal Vancouver Island Health Authority documents reviewed by Filter show in detail the province’s intention. 

Between September 2023 and April 2024, Island Health had been drawing up plans to provide OPC services in tents and vans outside the Nanaimo hospital and then the Victoria hospital, followed by Campbell River Hospital.

The documents show that the health authority expected outdoor consumption guidelines to be released over the summer.

“Facility Based OPS,” the term used by Island Health, would have been furnished with two tables and four chairs per tent. In Nanaimo, the vans would be parked in front of the tents, which would be set up on grass so that “no parking spots will be taken.”

But by April, the documents show “all work paused based on government direction.” That was when a zero-tolerance policy toward unregulated drug use in hospitals began coming into effect in BC, amid a federal directive to recriminalize simple possession and public use.

Both the provincial and federal health authorities pointed Filter to existing services for people who use drugs at both hospitals, which center on withdrawal management.

“Operating an unapproved clinical service or demonstration on Island Health property cannot be supported,” Vancouver Island Health Authority Chief Medical Health Officer Dr. Réka Gustafson told Filter on November 18. “This position is not meant to dissuade advocacy but rather to ensure that all services provided on Island Health property adhere to regulatory, safety and clinical standards.”

Hours after the Nanaimo pop-up closed at the end of its first day, a well-known, well-respected community member died of overdose in one of the Regional General Hospital bathrooms, alone. He’d been one of the first patients to access the Nanaimo OPC earlier that day.

“This is exactly the example of things that are happening on a devastatingly regular basis at our hospital,” Dr. Jess Wilder, who organized the Nanaimo OPC, told Filter. “This person, when they had access to a safe site to consume their substances, they chose to access it … when they do not have that option, they’re left with crappy options. Like dying in an emergency department bathroom. We all knew this patient. It’s incredible how many connections he made and how much everybody really loved him.”

“If we don’t get what we are very reasonably requesting from the Ministry of Health, I’m certain that we’ll be back,” Dr. Ryan Herriot, who organized the Victoria OPC, told Filter. “Our next project, after a little bit of recovery, is assisting other groups of health workers and concerned citizens across the province or across the country to do this.”

Dozens of vehicles passing the OPC at both sites, some of them bearing Island Health logos, honked in support of their efforts. The Doctors for Safer Drug Policy volunteers said they’ve been contacted by health care workers across the country, and by people in all walks in life, about replicating the initiative elsewhere. 

“To clarify, BC is not designating all hospitals for overdose prevention sites,” the provincial health ministry told Filter.

Photographs via Brishti Basu. Screenshots via Anonymous.

The post Documents Show BC Scrapped OPC Plan at Hospitals Where Pop-Ups Ran appeared first on Filter.

“I’ve never used inside the hospital, but I know a lot of people that do,” Jared told Filter. “What is the alternative?”

The morning of November 18, a pop-up overdose prevention center (OPC) appeared on the grounds outside Royal Jubilee Hospital in Victoria, and another outside Regional General Hospital in Nanaimo. Neither has been authorized by the BC Ministry of Health. If they’re not shut down, volunteers—around 50 social workers, outreach workers, doctors and nurses altogether—should be able to run the Victoria site for three days over the course of the week, and the Nanaimo site for five days. Though the canopy tents may be something of a surprise to the provincial government, patients who use unregulated drugs have been made aware of the services.

Dr. Jessica Wilder, a family and addictions medicine doctor spearheading the pop-up at Nanaimo, said that the hospital sees overdoses on a weekly basis. Without anywhere to safely manage their withdrawal on hospital grounds, people are using alone in the bathrooms, or leaving the hospital against medical advice.

“The only difference by having an overdose prevention site on hospital grounds is that there’s somebody standing by who’s trained to respond and provide lifesaving medication if something goes wrong,” Wilder told Filter. “For my patients who are in the hospital, it allows them a safe place to go to use [and still] stay in hospital and receive the care that they need and deserve.”

In 2023, BC had plans to open sanctioned OPC outside hospitals in Victoria and Nanaimo, as well as Campbell River. But in spring 2024, amid political backlash against harm reduction—including complaints about drug use inside hospitals by members of the BC Nurses’ Union—the province rolled back its decriminalization pilot. The sanctioned OPC never materialized. The BC Ministry of Health did not respond to Filter’s request for comment.

According to outreach workers, in the week prior to the pop-ups opening at least nine people in Victoria have died of overdose. Jared told Filter that he knows two people who died of overdose while he was in the hospital. He plans to use the Victoria pop-up while it’s open, and would use forensic drug-checking services if they were available too. 

In the United States, the push to legalize OPC refers to highly regulated brick-and-mortar sites that will always offer on-site forensic drug-checking with Fourier transform infrared spectroscopy. Commonly known as FTIR, this method can indicate which substances are present in a drug sample, and give at least some indication of the overall composition, without destroying the sample so that the participant still has the option of using it. 

In Canada, where harm reduction services are comparatively more established, well-resourced sites authorized by the federal government are known as “supervised consumption sites,” while the term “overdose prevention sites” generally refers to lower-barrier community spaces like outdoor tents. Some of the latter have received authorization from the provincial government, but they often begin as pop-ups operating without it.

“Let’s say you’re in hospital for leg surgery and you have a nicotine addiction. Of course, we give people nicotine patches, nicotine gum, everything possible to make it so that person doesn’t have to smoke,” Dr. Ryan Herriot, a family and addictions medicine doctor who is leading the OPS in Victoria, told Filter. “Nevertheless, some people have to smoke and so they go to the smoke pit. We’re honestly trying to just do that, except the difference is that people die if they can’t do this in the same way.”

These two sites won’t have forensic drug-checking, but Herriot said it’d be a great idea if a second iteration of the pop-ups were necessary.

Both Herriot and Wilder are hopeful that the government will recognize the value of the OPC and not interfere. They’re also well aware that the current political climate is not one that favors this.

“I would be really disappointed if there were negative consequences to my career,” Wilder said. “I’m really just hoping for a conversation to come out of this, so that we can continue to work together.”

Herriot expressed a similar sentiment.

“Our hope here really is to open up a dialogue with the provincial government such that they fund this and establish this,” he said. “In a prompt way, with paid staff and permanent infrastructure.” 

Photographs via Brishti Basu

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Using administrative health data from 2015 to 2019, researchers at the BC Centre on Substance Use and the University of British Columbia tracked MAUD access at community pharmacies. The study, published July 24 in Addiction, is the among the first to analyze long-term treatment retention for AUD.

The researchers found that AUD was most prevalent among men over 45, but that younger women were the demographic most likely to access MAUD, especially those living in urban centers where the concentration of services is higher than in rural areas. Though provincial health guidelines recommend utilizing MAUD for a minimum of three months, under 5 percent of patients ended up doing so.

Coauthor Dr. Seonaid Nolan, an addiction medicine physician at St. Paul’s Hospital in Vancouver, said the main barrier is that most health care providers don’t receive any formal addiction medicine training—whether related to alcohol or any other substance.

“Because of that, they don’t incorporate the screening, diagnosis or management of substance use disorders into their clinical practice,” Nolan told Filter. “It’s a medical education problem.”

Our interview has been edited for length and clarity.

“There isn’t an established treatment system.”

Brishti Basu: Why are so few people with moderate or severe AUD accessing medication, despite it being a recommended first line approach?

Dr. Seonaid Nolan: Historically, training in addiction medicine has not been integrated into medical education. As a result, there really isn’t a lot of widespread understanding around how to effectively screen for, not just AUD, but all substance use disorder (SUD).

Because [providers] didn’t receive a lot of training, there’s a level of discomfort … with prescribing these medications. The family physician, for example, doesn’t entirely know what to do in terms of generating a treatment plan. Even among primary care providers, there isn’t an established treatment system [where they can] refer their patients for assessment, if they do identify someone with AUD.

It would be neglectful, I think, for any health care provider to not have an understanding of how to treat basic medical conditions like diabetes or high blood pressure. My overall goal would be to see SUD at that level where there is an expectation amongst frontline clinicians that they’ve had some degree of exposure and training. And that they incorporate screening, diagnosis and management into their day-to-day clinical practice. 

I think a lot of it does come down to the medical education curriculum that’s provided to trainees and ensuring that they have the basic skills. The provincial and federal government, the onus on them is to help fund and make training programs available and incorporated into the curriculum.

And there’s the historical attitude around [alcohol] use being a “lifestyle choice” rather than a chronic [addiction] when compared to, for example, opioids or stimulants. Because alcohol is legal. There is sort of a cultural norm.

“This is part of the intricacies of treating SUD: There’s no one-size-fits-all approach.”

What are some of the reasons an eligible patient might not want MAUD?

The two that we generally use, naltrexone and acamprosate, are actually fairly well tolerated. Both can provide some mild gastrointestinal side effects … perhaps mild nausea, a bit of a headache, some loose stools, but generally both medications are not associated with any sort of significant side effects.

If someone has a problem with their liver function, naltrexone is not the best medication and we would consider acamprosate. Conversely, if they had kidney troubles we likely would not prescribe acamprosate but would prefer naltrexone instead.

Naltrexone is once a day, whereas acamprosate is three times a day. For some people, remembering to take medication even once a day can be a challenge. 

Some people aren’t interested in medications at all, and that’s just personal choice. They’re really keen on things like counseling and 12-step programs, or other sort of non-faith based group programs. Or cognitive behavioral therapy, or motivational interviewing.

This is part of the intricacies of treating SUD: There’s no one-size-fits-all approach. It really comes down to developing an individualized, tailored management plan. 

Psychosocial treatment modalities combined with medication have been more effective than just providing medication or psychosocial interventions on their own. Generally we try and offer anything and everything to patients, but the challenge comes down to accessibility of those programs. 

“It’s impossible to treat SUD without also addressing the other social determinants of health.”

What are the common barriers? Whether based in bureaucracy or stigma, or both.

Cognitive behavioral therapy, for example, often isn’t covered through the health care system. That, combined with the underprescribing of medications, has really provided a setting where people with AUD find it quite challenging to access [services].

It’s impossible to treat someone’s SUD without also addressing the other social determinants of health. If someone is unstably housed, bouncing from shelter to shelter or living on the streets, [medication isn’t necessarily] their first priority. And that’s totally understandable.

Housing and addiction treatment reside within different ministries in the provincial government. It’s challenging [because] there’s a level of coordination … that’s needed between those ministries.

We’ve certainly seen an increase in the number of people saying they used alcohol to cope with the pandemic.

The number of MAUD prescriptions did increase between 2015 to 2019. Does that indicate that the health care system is diagnosing AUD more efficiently? Providers are becoming more informed? Both?

It may be a combination of both. I don’t know that there would be reason to believe that the prevalence of AUD in the general population has significantly increased during the study time period. I think it probably more relates to the increase in the number of prescribers who are educated and trained in addiction medicine, and the expansion of access to specialty services. Particularly in the urban areas of BC.

There is some limitation around the health-admin data pertaining to medication use, because … though someone may pick their medication up from the pharmacy, that doesn’t, in fact, mean that they’re taking their medication.

In my clinical practice, we’ve been providing more prescriptions to help people with their acute withdrawal, but also with their long-term recovery goals. We’ve certainly seen an increase in the number of people who come to [the] clinic stating that throughout the pandemic … alcohol [has been] a coping strategy for a lot of the anxiety and the stress that accompanies those difficult few years.

Image via United States Department of Veterans Affairs/iStock/RapidEye

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In August and September 2020, researchers conducted interviews with 42 supportive housing residents and 30 staff from Interior Health, the regional health care authority that oversees public health care in Kelowna. Residents described a pattern of ongoing discrimination—particularly impacting those who use drugs. Many residents reported that after a provider noticed signs of drug use, including cigarette smoking, they were refused the care they needed. The research was published in the May 2023 issue of the BC Medical Journal.

“[Providers] had refused to come into people’s homes due to … cigarette smoke in the air,” lead author Dr. Hannah Gibson told Filter. “One [patient] was refused care because of drug paraphernalia in the home—so, not actively using the substance in front of the worker, but just having that paraphernalia there.”

Kelowna currently has six supportive housing facilities, three of which were included in the research. One had an in-house safe consumption site; the second did not, but did offer supplies like naloxone; and the third did not offer harm reduction services.

The province houses people “according to their needs,” but it’s not clear to what degree people who use drugs are intentionally assigned to the harm reduction-oriented facilities. Nor is it clear to what degree the residents of those facilities who need home health care are actually receiving it.

About three out of four residents interviewed require care for two or more chronic conditions, yet only about one-third had accessed Interior Health services. More than half reported not knowing that such services were available. Others reported that they knew, but either could not access the services or weren’t comfortable trying. Interviews with providers yielded similar findings.

Interior Health is one of five regional health authorities in the province, and the only public health care provider for Kelowna. Representatives declined to comment on the reports of staff withholding care, or on their policies related to patients who use drugs; they did, however, email Filter a statement describing the study as “an important body of work” that will help the “address and acknowledge some of the gaps” in its services.

“If you are having a mental health issue that could be substance use related, then you’re turned away from actual support around your mental health until your substance use clears,” one Interior Health provider told the researchers during their interview. “So that’s a problem for most of our residents.”

Dr. Gibson emphasized the importance of health care workers receiving training specific to substance use and behavioral health.

Dr. Gibson, who previously spent a year working as a provider at one of the facilities in the study, emphasized the importance of health care workers receiving training specific to substance use and behavioral health conditions. She pointed to Ellis Place, a 38-unit supportive housing facility that opened in November 2020, as a model—unlike most Kelowna supportive housing, it has in-house staff trained to work with those patient populations.

In addition to specialized training, other measures that the study authors suggested could make services more equitable included expanded hours; mobile outreach teams; and allowing people to opt for “wet” or “dry” housing. None of the three facilities explicitly prohibit substance use, and some residents who don’t use drugs—especially those in recovery—might prefer “dry” housing, just as residents who do use drugs benefit from increased access to in-house harm reduction services.

Both Dr. Gibson and Interior Health told Filter that since the interviews took place, the provincial government has funded more mobile outreach health care services, including a new outreach-oriented primary care unit.

Amid an escalating affordable housing crisis, the population of unhoused people in BC continues to swell. As of September 30, 2022, nearly 1,000 people were waitlisted for supportive housing, alongside another 1,200 applicants to other forms of subsidized housing.

Top image via Crisis Line Association of British Columbia. Inset image via BC Medical Journal

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In February, Black filed a lawsuit against the province of Alberta over a new regulation that severely restricts access to safe supply medications like hydromorphone. On March 2, Justice Colin Feasby granted Black a court injunction that temporarily exempts her from the regulation.  

Feasby noted in his court report that when Black was a teenager she’d been physically and sexually assaulted by an older man. At one point she was hospitalized, and prescribed hydromorphone to manage her pain. Eventually, when her prescription ran out and left her in withdrawal, she began using illicit fentanyl.

“I would spend all of my time trying to figure out how to get more fentanyl, putting myself into dangerous positions to get more, figuring out how to get money,” Black told Filter over video call. “That took a lot of my effort … it was a really, really dark time in my life. It was very, very chaotic, very, very dangerous.”

She overdosed several times. She repeatedly attempted to remove herself from the street supply, trying both methadone and buprenorphine, but neither were a fit. She spent months trying to make them work but feeling constantly ill, unable to eat or sleep properly. She experienced suicidal ideation.

“I just felt like I was watching my life, rather than actually living it,” she said.

She went back to illicit fentanyl. Then, in May 2021, she found a doctor who believed her. Dr. Helen Bouman, an addiction medicine physician at the Opioid Dependency Program (ODP) clinic in downtown Calgary, worked with Black to find the right dose of the right safe supply medication until they arrived at the regimen she uses today.

“My veins are all in excellent condition. There’s no hardness, there’s no scarring.”

“I started with taking six or seven doses per day,” Black said. “Now I’ve worked my way down to three.”

Each morning, Black picks up her day’s supply of hydromorphone from her local pharmacy. British Columbia and Ontario have approved the safe supply practice known as Tablet Injectable Opioid Agonist Therapy, but Alberta has not. The prescription Black receives is technically for oral use, and it’s understood that, like many people, she’ll crush and inject the tablets because that’s the formulation that works for her.

At home, with cat Nyx and dog Huxley 

Three times a day, Black prepares her hydromorphone. She uses sterile water, a sterile needle, wears sterile latex gloves and even a mask to safeguard against contamination of her shot. She uses a tourniquet and takes the time she needs to anchor the vein and inject slowly and precisely.

“Back then I would be jabbing my arm over and over again trying to get a vein. Now … I literally only ever poke once,” Black said, holding up her forearms. “My veins are all in excellent condition. There’s no hardness, there’s no scarring. You see?”

The ODP clinic is now the only place in Calgary where safe supply medication can be legally consumed, and this must be done under supervision. Without her injunction, Black would be forced to spend four hours each day traveling back and forth to the clinic, which is also closed by the time she takes her third dose of the day.

“I believe that as a result of the Treatment Regime, Black has experienced an improvement in her physical, mental and social health,” Bouman wrote in her court affidavit. “Black has demonstrated her commitment to her Treatment Regime, which is a safer and better alternative to toxic street-sourced opioids.”

Working on craft projects with cat Pepper

In addition to regaining control of her physical health, safe supply has alleviated Black’s need to constantly spend time and energy and money on staving off withdrawal. The past two years have seen her deepen her personal connections with her mom, her friends, her books and her life in general. 

“I don’t take dumb risks. I stopped using stimulants. I stopped smoking cigarettes. I paid off my debt,” Black said. “This prescription has basically allowed me to have a stable foundation [to] build a healthy and safe life.”

In the two years Black has been on hydromorphone, the only time she’s overdosed was when she was traveling to Edmonton and found herself unable to get her prescription from the pharmacy. If Alberta appeals her injunction, she will find herself in that same position.

Even if she’s left alone, the injunction is still temporary and will have to be tried in court.

“Any burden that is created … is a result of the Applicant’s place of residence or her personal lifestyle choices.”

In its written brief, the provincial government claimed that Black’s charter rights—life, liberty and security—are not being violated because by not traveling four hours each day, she is choosing to “deprive herself of effective treatment.”

“Any burden that is created … is a result of the Applicant’s place of residence or her personal lifestyle choices,” it stated.

In granting the injunction, Justice Feasby wrote that, at least for now, he “cannot accept that this is a choice on Ms. Black’s part; it may be part of her condition.” He noted that the issue at the heart of the trial is whether the province’s new restrictions will be considered “mere inconveniences or significant obstacles to necessary treatment.” All parties acknowledged the danger Black faced if she returned to street supply.

Black said that no government representatives or health officials have tried to contact her.

“I wish that someone from the government would speak to me, would meet me, would see who I am. Sometimes I feel like the government just sees me as an addict and nothing else.”

Top photograph courtesy of Darcie Dark. Inset photographs courtesy of Ophelia Black.

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