Research for solutions to the drug poisoning crisis is under attack.

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Friends, family, neighbours, and loved ones continue to die of drug poisonings and overdose across the country. As 2023 draws to a close, most Canadians have been touched by the drug poisoning crisis in some way. We recognize that this is a complicated issue, and we support ongoing efforts by doctors, nurses, and researchers to develop and test potential solutions and treatments. Safer supply programs, where patients are provided with a known quantity of medication as an alternative to unregulated street drugs, have shown great promise in ongoing small trials and studies. While this is an intensive intervention, we cannot afford to miss any opportunity to make a positive difference and save lives.  

Solving complex problems requires patience, perseverance, and strict adherence to an objective assessment of outcomes. As the drug poisoning crisis continues, we must stay close to the principles of science and avoid allowing personal assumptions, fears, and anecdotes cloud our judgment. Unfortunately, science and objectivity have not been at the forefront of this discussion.  

As healthcare providers, we know that we must be consistent, systematic, and determined in our search for solutions to this complex crisis. Many people have rightfully been increasingly frustrated and discouraged as we witness the many harms of the poisoned drug supply skyrocket. Despite these very real challenges, we wish to encourage our healthcare colleagues, the public, and policy makers, to adhere to evidence-based principles while making decisions. In clinical medicine, if harm is seen in an experimental intervention, the trial must cease. This is how we protect public safety and the safety of study participants. If an intervention shows promise of benefit, however, it continues with sound methods and ongoing monitoring. This is how cures for diseases are developed, and robust health interventions and systems are built. To date, empirical and systematically collected evidence of harm has not been presented, thus further inquiry should proceed – the potential benefits may still outweigh the risk of harm. Promising new treatments for one of the country’s most deadly and pressing health emergencies warrant ongoing scientific inquiry.  

It is important to recognize that the risks of death and serious harms associated with this poisoning crisis are being disproportionately borne by Indigenous populations who have been historically and contemporarily subject to discrimination and racism. The colonial legacy of poverty, violence, and marginalization continues and is playing a major role in this crisis. This is yet more reason to set our personal biases and anecdotes aside and to get to work collaboratively generating more science. There is high quality evaluation and research ongoing in the safer supply programs being piloted in Canada. These programs may be new but emerging evidence does not demonstrate that safer supply models are playing a role in increasing drug poisoning deaths. So far, Canadian safer supply programs have been shown to reduce the use of unregulated drugs, reduce the risk of death from drug poisoning, decrease emergency room visits and hospitalizations, reduce infectious complications, decrease health care costs, and result in better controlled drug use, and improve overall physical, mental, and social well-being.   

It should be noted that although some signatories may be involved in the delivery and evaluation of these programs, the vast majority of signatories here are not directly involved nor invested financially in safer supply initiatives, nor have any affiliations with for-profit addiction medicine including return-to-work monitoring programs or have other financial or personal conflicts of interest.   

We therefore express our collective recommendation that ongoing high quality research should proceed. Summarily dismantling programs with active participants in the midst of evaluation, without clear evidence of harm, is unethical and places the entire foundation of peer-reviewed scientific inquiry at risk. Rather, given early promising research, programs should be carefully expanded, refined as further evidence become available, and scaled alongside robust evaluation programs. With 21 Canadians dying per day, the need to properly, and objectively, evaluate promising and innovative interventions is urgent if we hope.to reduce ongoing harms associated with this public health crisis.   

For more information:

• https://www.nss-aps.ca/resources
• https://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis/safer-supply.html
• https://news.gov.bc.ca/releases/2023PSSG0066-001496