Canadian teens hooked on opioids via "safer supply"

Investigation suggests lower-income youth in Vancouver suburb could be collateral damage of safer supply programs and "dillies"

Madison was just 13 when she first tried hydromorphone, a drug commonly known as “dillies.” She quickly became addicted and, after a few months, began abusing fentanyl. 

It almost killed her several times.. Now, two years later, she is in recovery and wants Canadians to understand that hydromorphone abuse is rampant among her peers in Port Coquitlam. And she believes Canada’s ill-conceived “safer supply” programs are a big part of the problem..

“Safer supply” is an experimental policy that provides free pharmaceutical opioids as an alternative to potentially-tainted illicit substances. Health Canada claims that safer supply reduces overdoses and deaths. But since January, I have interviewed over 25 addiction medicine experts who claim that widespread fraud has actually rendered the policy a failure.

The problem is that hydromorphone, the primary drug distributed by safer supply, is too weak to get fentanyl users high, even though it is as potent as heroin. Experts widely allege that drug users consume just enough hydromorphone to pass urine tests, and then traffic – or divert as the experts euphemistically say – the rest on the black market to purchase harder substances.

The market impact of diversion is stunning.

Addiction physicians across Canada claim it has caused hydromorphone’s street price to collapse by 70 to 95 per cent in areas where safer supply programs are active, and that the drug often ends up being sold to individuals with lower opioid tolerances. This has allegedly led to a wave of new addictions, particularly among youth.

Madison’s experiences poignantly illustrate this tragedy.

We spoke on the phone one weekend in early June while she was in rehab. 

The 15-year-old’s voice, though soft and vulnerable, sometimes swelled with pain and indignation as she recounted what opioids had done to her. 

“​​It’s not okay that people aren’t seeing this and how it’s destroying lives,” she said. “Not only our lives, but our family’s lives. And everyone around us.”

According to Madison, dillies suddenly became ubiquitous among her peers shortly after the COVID-19 pandemic subsided, a year or two after safer supply programs were scaled up by the federal government. Around 2021, an old friend learned about hydromorphone and started procuring it from downtown Vancouver to sell to Port Coquitlam teens, she said. The dealer allegedly told her that hydromorphone is “just a pain reliever and that it doesn’t hurt you and that it’s actually good for you.”

She remembers the first time vividly.

“It made me feel like a zombie and it felt like I could do anything in the entire world.” 

She was hopelessly addicted within a few weeks – an acute awareness set in when she realised she needed dillies every morning just to function, and could no longer go to sleep without them.

The addiction wreaked havoc on her mental health. 

“I became isolated and felt like I was slowly dying – and it made me feel depressed and angry,” she said. Yet it was easy to maintain her habit as the drug was readily available and highly affordable. For a girl growing up in a working class family, this was an important consideration. 

“I never really had a lot of money and it was very hard for me to get money,” she told me. “ They were just super cheap and easy to get.”

According to Madison, all her close circle of friends got hooked on hydromorphone. She believes about 30 or more schoolmates have abused the drug. 

And what she said next unnerved me.

She claimed six or more peers seem to have died from hydromorphone-related overdoses. But it was unclear, from our conversation, whether these overdoses were directly caused by the drug or by other substance use that may have been concurrent to hydromorphone addiction.

“I was dying – slowly and slowly”

I asked her to recall details of what hydromorphone had done to her peers.

She remembered how, last summer, a friend overdosed while “drinking and doing dillies.”

 She said he “fell down to the ground and stopped breathing and couldn’t talk and was trying to tell us that he’s fine.”

 The situation then “got to the point where he wasn’t alive anymore” and they “had to call the ambulance, and they had to save him right in front of all of us.”

The traumatic experience – something Canadian youth should never have to witness – “was because of the dillies,” she said.

I have not yet been able to independently verify Madison’s claims about the six deaths, but her story of rampant hydromorphone abuse and overdoses was consistent with the testimony of two other girls, Emily and Hannah, and several parents, who I interviewed for a recent story in the National Post.

That story focussed on Kamilah Sword, a close friend of all three girls who, like them, struggled with hydromorphone addiction. 

Kamilah died of an overdose last August, devastating her friends and leading some of them to seek treatment. Her father, Greg Sword, says based on what officials from B.C. Coroner’s Service said he believes hydromorphone caused Kamilhah’s death.

Emily, Hannah and Madison’s stories all align and appear to validate the concerns expressed by addiction experts regarding safer supply diversion’s impact on young people. 

The girls said that hydromorphone is widely abused by their peers, children as young as 11 used it, and the drug’s risks  are downplayed to new users. Once hooked on hydromorphone, all three girls were pressured to take more expensive substances, such as heroin.

They also said that the hydromorphone flowing through their community often originates from Vancouver’s safer supply programs. Drug dealers would allegedly travel to downtown Vancouver to buy dillies, where, according to Hannah, 60 tablets can be purchased for $40, and then radically mark up the product in Port Coquitlam for $5 to $10 dollars per tablet.

To save money, the girls would sometimes go to the epicentre of Vancouver’s opioid deathzone – Main and Hastings – to buy the drug directly. 

“We would go to Hastings. And if [dealers] didn’t have [dillies] on them already, then we would go with them to the pharmacy and they would go in and get them and sell them to us,” said Madison.

She recalled once waiting outside a Downtown Eastside pharmacy while a safer supply recipient scammed the system to score opioids for her.

It works like this, she said.

“Homeless people” would tell pharmacists that they needed free hydromorphone as an alternative to illicit substances, and would then sell their safer supply on the street. When asked how she knew what narratives were being told to these pharmacists, Madison said that drug users had shared this information with her friends and that she had also heard this directly from a dealer in the Downtown Eastside. 

Over time, Madison’s opioid tolerance grew and hydromorphone stopped being enough for her.

That’s when she began using fentanyl. According to addiction experts, this type of escalation is a common issue with hydromorphone diversion, which is why experts are concerned that safer supply is exacerbating, not mitigating, the fentanyl crisis.

The more opioids Madison used, the worse her overdoses became. By her estimation, she overdosed approximately seven times before finally entering rehab.

One time, after overdosing in a Skytrain station and being revived with Narcan, she awoke on the ground and could barely walk. 

“My whole body felt like I was dying – slowly and slowly.”  

After coming back to life, the first thing she craved was to use opioids again. But the police took her home. At the insistence of her mother, Beth, the officers searched Madison and confiscated a bottle of hydromorphone. But that was it. They did nothing else.

From my interviews in Madison’s circle, it seemed that B.C.’s health and law enforcement systems provide teens with little protection from serious drug harms. Parents like Beth have found the opposite. The system is pulling youth towards death.

“I’ve never met so many teenagers who are drug addicts before,” Beth told me in a phone interview. “ A huge majority of teens are using because it’s so easily available.”

She recalled that Madison would “cry and scream and flail around because she needed the dillies.” 

Beth says she did her best to protect her daughter but government support was often simply not there.

“There’s one youth detox centre and one youth rehab centre in Vancouver that is covered by the government,” she said. “One. And if you go outside of that, it is $10,000 a month to try and get your child help. And I’m a single mom. I can’t afford $10,000 a month to save my child. It’s fucking insane.”

At one point, Madison saw a doctor who, in an effort to address the girl’s fentanyl addiction, prescribed more hydromorphone – the very drug she was already abusing and which had led her to fentanyl abuse.

When Madison asked how this made sense, the doctor allegedly told her that hydromorphone was “not bad” and that it would “balance things out.” 

The tone-deaf response exasperated the family.

Madison continued to abuse fentanyl, even after detoxing several times. 

Not even the death of Kamilah, her close friend, could break the habit. Quitting opioids, already a herculean task under normal circumstances, was made near-impossible by hydromorphone’s omnipresence in her community. Madison said that, even today, she “can’t even go out without seeing it and wanting it,” which is “very triggering.”

Yearning to live

Yet something finally shifted within Madison.

While staying in Creekside, a publicly-funded withdrawal management centre, she saw a boy who was “literally mentally dying.” She sensed he “didn’t want to stop.” 

She started talking to him, hoping to give him the courage to turn his life around, but the more she spoke, the more her own courage welled up inside her. She decided that she was going to fix herself and demand a good life.

When we had our interview, it had been two months since Madison entered rehab – something which she said felt “amazing.” 

She broke down as she spoke about her mom, who had always been there for her. 

“She loves me more than anything.” 

With the help of traditional addiction treatments, such as opioid agonist therapy (i.e. methadone, Suboxone), she is preparing to start over. 

“I’m so young. I’m 15 years old and I shouldn’t be going through this. I shouldn’t have done any of that – and it ruined my life.” 

When asked what she would tell youth who are considering trying hydromorphone, her response was blunt. 

“Don’t do it. It ruins your entire life. You’ll never be the same person, ever.”

Madison is a living, breathing person, and yet safer supply advocates, including their allies in the federal and B.C. government, insist that reports of youth accessing diverted hydromorphone are just myths. 

What struck me as even worse, B.C. Chief Coroner Lisa Lapointe made a speech in April where she argued that, even if youth die from diverted hydromorphone, these deaths would be acceptable collateral damage for the safer supply system. I’ve cited the whole statement to let Lapointe’s reasoning speak for itself.

“I had a conversation the other day with somebody in a position of influence in the government who — they are now looking, they are spending time and energy looking at this issue of diversion to youth,” Lapointe said. “It’s a very concerning thing, because the physicians are afraid that if they prescribe and it’s diverted to an opioid naive user, they may become opioid dependent and they may die. And I understand that. But that may happen to some people, but the fact is that six people are dying every single day of every single week of every single month of the last two and a bit years.”

“That’s the fact,” Lapointe concluded.

When I asked Madison what she would say to adults who think that dillies are a non-issue, she got righteously angry.

“I’d say ‘Fuck you – like, seriously. You’re stupid! How can you not see all these kids dying and getting sick with this addiction. It’s serious. It’s not okay.”

Denying the Data

In recent weeks, B.C. officials have emphatically claimed that there is no sign that youth are using diverted safer supply hydromorphone.

However, in mid June, the B.C. Coroner’s office released a report which included, for the first time, data about recent youth drug deaths. The data, which spans January 2017 to December 2022, shows that hydromorphone was present in 0% of youth drug deaths between 2017 and 2019. Then, in 2020, which is the year that safer supply became widely available, that number grew to 5.5% – before rising to 9.6% in 2021 and 22.2% in 2022.

When Global News reported that two young women allegedly developed opioid addictions after purchasing diverted hydromorphone, the B.C. Ministry of Mental Health and Addiction responded “there is no way to know the source of drugs purchased on the streets, even if a dealer claims it is from prescribed safer supply.”

The ministry’s statement was factually incorrect. 

Addiction physicians say that the source of hydromorphone can sometimes be determined by attached prescriptions or labels. The B.C. government also appeared to be contradicting itself – officials cannot confidently assert that diversion is not happening and then, when presented with evidence of diversion, claim that it is actually impossible to know whether drugs on the street are diverted or not.

Lapointe has also recently emphasized that, according to provincial toxicology tests, hydromorphone has not been present in a significant number of overdose deaths. However, these comments misrepresent the situation. Addiction physicians say that hydromorphone diversion most likely causes deaths by creating new addictions that mature into fentanyl abuse – it is the fentanyl that kills users, not the hydromorphone, but hydromorphone remains the root cause of the death.

Madison’s case illustrates this point well. Had she continued to abuse fentanyl and discontinued hydromorphone (as often happens with fentanyl users, due to high tolerance), she could have easily died without having hydromorphone in her system. In that outcome, according to the methods used by the B.C. government and the province’s chief coroner, her death would not have been counted as a safer supply-related mortality.

She would have disappeared amid the statistics, erased by a broken system that pretends that people like her do not exist.

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This article was originally published in The Bureau, a Canadian publication devoted to using investigative journalism to tackle corruption and foreign influence campaigns. You can find this article on their website here.