One hot morning this summer, a group of weary-looking men and women gathered outside the door of a Hamilton pharmacy, waiting for opening time.
asserted
group → gather → time
Just before 9, they started filing through the door to collect the medicines they take for their various addictions.
asserted
they → file → addictions
The meds are designed to help them fend off the agony of withdrawal and perhaps even get on the road to recovery.
asserted
them → design → recovery
But within minutes of emerging, one of them, a bearded man in a baseball cap, was emptying his bottle of pills into the palm of another guy, who in return gave him a small handful of a yellowish powder: fentanyl, the potent opioid that causes most drug overdoses.
asserted
that → emerge → overdoses
Transactions like this are commonplace on the streets of Hamilton, so routine that those involved hardly bother to conceal them.
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those → involve → them
This one took place just around the corner from the pharmacy on James Street South, a busy avenue in the heart of the city.
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one → take → city
The two men exchanged their drugs right in front of me, after I explained who I was and what I was writing about.
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I → exchange → what
The pills were a potent painkiller called hydromorphone.
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pills → call → ?
Sold under the commercial name Dilaudid, they are normally used to treat severe pain from cancer, bone fractures or burns.
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they → sell → cancer
About a decade ago, some doctors began prescribing them to people with addictions.
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doctors → begin → addictions
They reasoned that, with fentanyl flooding the streets, it was safer for patients to satisfy their need with a regulated, prescription medication than a dangerous, illegal drug.
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patients → reason → drug
Health authorities sanctioned the practice, which became known as safe supply or safer supply.
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which → sanction → supply
Before long, though, evidence started to mount that many patients were selling or exchanging the pills, which became popular street drugs in their own right.
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which → start → right
In 2021, Hamilton police seized a total of just eight hydromorphone pills.
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police → seize → pills
Last year, they seized 1,639.
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they → seize → 1,639
The price has dropped as the supply has increased, until a pill cost less than a can of beer.
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pill → drop → beer
Authorities eventually woke up to the problem – known as drug “diversion” – and governments began imposing more controls.
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governments → wake → controls
, safer supply continued to thrive.
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supply → continue → ?
A group of 36 alarmed physicians wrote to the Ontario government in July demanding action.
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group → write → action
One of them, Lori Regenstreif, 63, used to work at a clinic just a few steps away from the James Street pharmacy where the pills-for-powder trade happened.
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trade → use → powder
She told me her “blood boils” over what the mass dispensing of safer-supply drugs is doing to her patients.
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dispensing → tell → patients
Because hydromorphone pills are so easy to get, some of them are falling back into using street drugs after years of stability on the standard addiction medicines she prescribes.
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she → get → medicines
“You are turning people into criminals instead of patients,” she says.
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she → turn → patients
“They’re trying to move forward, and you’re pulling them back in.”
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you → try → them
With doctors like her raising a fuss and the media asking more and more questions, regulators began moving this week to further tighten the rules on safer supply.
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regulators → raise → supply
But not before the program caused what she calls “horrible” damage in cities like Hamilton.
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she → cause → Hamilton
Dr. Regenstreif took me on a tour of its downtown, pointing out the addiction pharmacies that dot the city and the struggling people who congregate outside them.
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who → take → them
Over the next few weeks, I spoke with doctors, pharmacists, addiction experts, police, community leaders and drug users on the streets.
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I → speak → streets
What emerged was a picture of a well-intentioned policy gone wildly off course.
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emerged → emerge → course
Though federally funded clinics supplying safer-supply drugs closed down, and the provincial government banned new ones, individual doctors kept prescribing large quantities of hydromorphone pills.
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doctors → fund → pills
A network of pharmacies and clinics sprang up to distribute them.
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network → spring → them
Taking advantage of a billing system that rewards them for the heavy traffic they get from addiction medicine, they collect fees from the health system and send their customers out the door with bottles of highly addictive medicines, which then make their way into the street-drug market.
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which → take → market
The spread of the pills echoes the origins of the opioids crisis, which began with the mass prescribing of addictive pain pills.
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which → echo → pills
Ontario neighbourhoods from North Bay to downtown Toronto are coping with the side effects, which include open drug use and dealing.
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which → cop → use
Dr. Regenstreif says she is seeing more and more young people turning to the pills, some of them in their early teens.
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people → say → teens
Indigenous communities are seeing more of them, too.
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communities → see → them
Safer supply sprang from the best of motives.
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supply → spring → motives
When drug overdoses started soaring a decade ago, advocates argued that we should treat the opioids crisis as a health, not a crime, problem.
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we → soar → problem
To reduce the spread of diseases such as AIDS and hepatitis C, they handed out clean needles.
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they → reduce → needles
To reduce the toll of overdoses, they offered people supervised places to take their drugs, with trained staff on hand to revive them in case they collapsed.
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they → reduce → them
…and 113 more, not listed.
The Aporia
