Drug diversion sparks return of panel reviewing London’s ‘safe supply’ programs

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The news that London police are seizing more opioids prescribed through safe supply programs has raised questions about who’s running the programs and what diversion safeguards are in place.

The region’s public health office doesn’t have “a direct line of sight” on who else, besides the London InterCommunity Health Centre (LIHC), is providing safe supply, Alex Summers, medical officer of health, said Tuesday.

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The centre’s program is “highly visible and heavily evaluated,” he said.

“When it comes to other operators of safe supply, they are independent practitioners and we have to better understand what’s happening and how we can support the management of diversion.”

How many supply programs there are in the region, who’s running them and what diversion protocols are in place are among the first questions a revitalized Middlesex-London community drug and alcohol committee will try to answer, Summers said.

London police released results on Monday from a six-month investigation that resulted in charges against 50 people and seizure of illicit drugs with a police-estimated street value of $790,000.

Among the drugs seized were 11,132 hydromorphone pills, under the brand name Dilaudid 8 mg. Police used a news conference to discuss the increasing number of pills seized in London that they say come from safe opioid supply programs.

Those programs provide pharmaceutical grade and safer opioids – the Dilaudid pills – in an effort to prevent people from buying much more dangerous street drugs that can include different levels of fentanyl mixed with other chemicals.

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Research into LIHC’s program has shown safe supply can improve the health and quality of lives of clients.

But the federal Conservative party has seized on safe supply and other harm reduction measures, such as supervised drug-use sites, as reasons for Canada’s opioid crisis and the 45,000 overdose deaths in the past decade.

The Conservatives issued a news release Tuesday using the London police information about diversion as proof of their claims.

But harm reduction supporters say diversion, while a key concern, is not a reason to shut down safe supply – which allows people to live and improve while they work toward treatment and recovery, if so desired.

LIHC has diversion protocols in place, executive director Scott Courtice said.

Patients in the safe supply program are required to provide urine samples to ensure hydromorphone is in their system, he said at the news conference Monday.

No hydromorphone in the system is a sign they might be diverting the pills, and a patient can be removed from the program, he said.

“Diverting a medication is breaking trust with the clinician in a very significant way,” he said.

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But health officials work with each patient to determine why they might be forced to sell or give away their pills, and put in place plans to help them, he said.

The centre will work with police and the health unit to review the diversion protocols, Courtice said.

But he noted there were at least three other suppliers in London serving, in total, more than the 280 patients at LIHC.

London police are eager to work with other community organizations on the drug and alcohol committee to help suppliers prevent diversion, deputy chief Paul Bastien said Tuesday.

“It’s in all of our interests not to delay,” he said. “I think we’re aligned in seeing this as a priority. Our role would be to support the role of health professionals. We can offer insights as a result of enforcement efforts, which will continue, and other observations.”

Police know of some of the other safe opioid suppliers, physicians and pharmacies, but like the health unit, isn’t aware of all of them, Bastien said.

“We would support the committee’s work in any protocol reviews involving other providers,” he said.

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Once the drug and alcohol committee assesses who else is offering safe supply, it can work with those physicians and clinics to develop diversion protocols, Summers said.

“We can develop principles and guidelines to how we want things to unfold and then, hopefully, influence partners to aim for those ways,” he said.

The committee is supported by the Middlesex-London Health Unit and in the past including members from policing, education, health care and social service sectors and people with lived experience.

The drug and alcohol committee hasn’t been active since the pandemic but is reconvening to deal with the many issues surrounding the opioid crisis, Summers said.

“We are in the midst of expanding our membership, developing some really action-oriented priorities and getting down to work. The announcements around the concerns of diversion offers one priority for the committee to work on,” he said.

rrichmond@postmedia.com

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