What Is a Safe Drug Supply?
The debate surrounding a safe drug supply has proven extremely polarising so far, in spite of the fact many among the most outspoken participants cannot even spell it. This article means to address this deficiency.
Have you ever wondered what this much-debated safe drug supply is about, but been too afraid to ask? Don’t worry, you’re not alone. And those pundits, proponents and detractors alike, that have been lecturing you about it may not have a clue either.
There is no answering what a safe drug supply is without first explaining what makes the street drug supply unsafe to begin with, so let’s start from the beginning:
Why do people overdose on drugs?
Of course the knee-jerk answer is that they consume too much of a given drug at once; it’s also a simplistic one. There are basically two factors leading to drug overdoses:
- The user consumes an unexpected substance: Our street drug supply is quite literally poisoned, contaminated with various random substances beyond the user’s knowledge. The most common is fentanyl, a very powerful opioid painkiller, while more recently xylazine, a benzodiazepine, has been gaining in prevalence. Some, including the latter, were never intended for human consumption.
- The user consumes a highly potent substance with wildly fluctuating dosage: Fentanyl in particular is so powerful that even a fraction of a pill may prove deadly, and of course street drug suppliers have no realistic way of standardising the amount that goes into a specific dose.
Why do people die of drug overdoses?
Of course some drug overdoses are invariably fatal. In particular, there is currently no way to reverse a xylazine overdose.
Opioids such as fentanyl, on the other hand, can be countered with naloxone, an opioid antagonist which temporarily blocks receptors, effectively countering the drug. It must, however, be injected into the bloodstream within minutes of an overdose, otherwise the patient dies of cardiorespiratory arrest.
In the latter case, it could be said that users die either because they were alone or because bystanders failed to administer naloxone in time, which is probable on the streets as opposed to a safe consumption site. The criminalisation and stigmatisation of hard drug use largely contributes to such unsafe behaviour and the ensuing fatalities.
Which contaminants are found in the street drug supply?
The short answer is that just about any conceivable substance, no matter how outlandish, can find its way into street drugs.
Of course some are more predictable than others, regardless of their toxicity or popularity. Fentanyl, for one, has proven so addictive that users actively seek it. In contrast, animal tranquilisers such as carfentanil and xylazine are unequivocally poisonous and prove usually fatal, and yet are similarly prevalent.
Some are relatively safe by themselves but may prove dangerous or even fatal if unexpected. THC, the psychoactive component of cannabis, is one such example, since it may lead to paranoia and hallucinations at high dosage, making the patient susceptible to anything from accidents to fatal police encounters. Likewise, psilocybin, the psychoactive ingredient in magic mushrooms, is a powerful psychedelic that can render an unwary user’s behaviour highly hasardous.
And then there are those so perplexing that they defy explanation. For example, synthetic cathinones, more commonly known as bath salts, can lead to excited delirium, an altered mental state which may induce random acts of violence; of course this one was never intended for human consumption either.
What is a safe drug supply?
A safe drug supply addresses the two main deficiencies of the street drug supply, by ensuring the substance is uncontaminated and its dosage accurate. Medicines dispensed at pharmacies naturally meet these criteria, as do legally purchased alcohol and cannabis.
Of course the term ‘safe drug supply’ is somewhat of a misnomer, as the underlying substance may hardly be considered safe to begin with (alcohol, for one, hardly is), but is less of a mouthful than, say, ‘unadulterated drug supply’, or restrictive than ‘pharmaceutical drug supply’.
Most advocates propose a safe hard drug supply in last resort, for patients that have exhausted all alternatives. For many patients, abstinence would amount to literal torture while substitute drugs such as methadone prove ineffective, leaving in most cases the street drug supply for only option—and effectively a death sentence.
Where does one find safe drugs?
There are already pilot programs sanctioned by government agencies supplying small numbers of users with safe drugs—although these may not meet everyone’s definition or expectations of a safe drug supply. One such program is the MySafe Project, which provides doses of hydromorphone from a palmprint-activated automated dispenser to selected participants.
The alternative is testing street drugs before dispensing them. The Vancouver-based Drug User Liberation Front purchases drugs from the dark web and resells those successfully tested against known contaminants. This practice, while saving lives, remains an infraction to the Criminal Code, although the authorities have so far refrained from shutting down the operation, most likely fearing public backlash.
To date, no single casualty has been recorded among users of the above.
Users may of course test their own purchases via drug checking resources such as the Substance program, run by the University of Victoria.
Who would pay for a government-regulated drug supply?
Last, but not least—and admit it, that’s the one question most are itching to ask. Let’s answer plainly then: that would be the taxpayer, as destitute patients could hardly be expected to foot the bill.
That being said, the taxpayer will foot the bill no matter which strategy is deployed to answer the drug overdose crisis. In the United States, the cost currently reaches about 150 billion dollars per year, may it be through health care expenses, law enforcement, or lost productivity; compared to that, the cost of supplying patients with safe drugs doesn’t seem such a bitter pill to swallow. And that’s saying nothing of the human toll.
References:
Acute pain management in patients with drug dependence syndrome — PAIN Reports
Vancouver Island Drug Checking Project Year End Report 2021 — Substance Drug Checking
BCCSU Drug Checking Project — British Columbia Centre on Substance Use
The High Price of the Opioid Crisis — 2021 Pew Charity Trusts
