The Hydromorphone Diversion Bogeyman Cometh

Lots had been said and written about hydromorphone diversion lately, from this editorial on the National Post to an interview by MLA Eleonore Sturko. According to detractors of safer supply programs, massive diversion of painkiller medication to be sold as street drugs is somehow spiking up drug overdose deaths while “fuelling fentanyl addiction” and hurting the feelings of doctors who feel compelled to prescribe medication, and that’s why we have to “stop prescribing dillies” or whatever.

While this all sounds scary, it’s also ominous gibberish. It’s meant to scare people without any grasp of the issue in order to score political points. Rebutting this argument vacuum is consequently tedious, but bear with me for a moment.

For starters, hydromorphone is neither a recreational drug like psychedelics, nor a stimulant like amphetamines. Those who take it are either in acute pain or already addicted to it (probably because they were once, you know, in acute pain). So these “dillies” are only diverted to those who need them.

And since they are being sold as street drugs, there’s a demand for them. They have to work for somebody, otherwise there would be no demand. And that somebody manifestly would rather not buy down from street gangs. It’s actually an argument in favour of expanding safer supply programs, but the irony is lost on those who purposefully resort to such word salads.

The diversion is somehow blamed for a rise in overdose deaths, but hydromorphone is safe—at least tremendously safer than street drugs laced with fentanyl and xylazine. And there isn’t nearly enough to make a statistical difference anyway. So there can be no plausible mechanism to link the two.

Of course critics call it “subsidising fentanyl addiction”, as if it somehow needed to be fuelled. In their vivid imagination, flooding the streets with “dillies” somehow jacks up fentanyl overdoses, because of course resellers couldn’t afford their drugs otherwise; god forbid they spend their welfare cheques, collect empties, beg, steal, or prostitute themselves. Some of these alternate sources of income aren’t quite safe, by the way.

But you see, this debate isn’t about saving lives; it’s about controlling the drug supply. Hardcore detractors would be just fine with cutting off addicts’ welfare, fining them to bankruptcy, locking them up in jail or on psych wards for involuntary treatment, and driving them to suicide. You think I’m exaggerating? Watch them brag about taking “dillies” away from patients showing up at the ER with severe pain. Or standing up by policies coercing patients into taking their meds under the scrutiny of health care professionals, like prisoners—even if that leads to drug overdoses, such as this woman being ordered to down an entire bottle of slow-release morphine.

Since a picture is worth a thousand words, I decided to counter nonsense with nonsense, using a stable diffusion program to produce a picture of a bogeyman captioned with gibberish, which has about as much substance as this manufactured controversy. Because only someone who lacks a proper grasp of the underlying jargon could confuse it with speech.