Enabling Addiction: a globally renowned drug expert speaks out against "safer supply"
Obama Administration expert warns Canada's 'safer supply' experiments are replicating lethal outcomes of OxyContin prescription crisis
One of America’s leading drug-policy experts is sounding the alarm on Canada’s “safer supply” programs, alleging that advocates who back these programs are recycling practices used by Big Pharma and Big Tobacco, and warning that the continuation of these programs will reproduce the lethal OxyContin crisis.
Safer supply “perpetuates addiction,” says Kevin Sabet, a former White House adviser who worked within the Clinton, Bush and Obama administrations. Sabet has advised some of the world’s most powerful figures, including Pope Francis, on addiction.
And his writing, which includes two well-regarded books, has been praised as “compassionate” and “meticulously factual.” He is also refreshingly nonpartisan, having been the only politically appointed drug-policy adviser in both a Democratic and Republican administration.
After relocating part-time to Vancouver in 2020, Sabet became keenly interested in Canadian drug policy. I sat with him for an interview at his home in July, where he shared his concerns.
Safer supply programs, which have been widely available in Canada since 2020, claim to reduce overdoses and deaths by providing free, government-supplied drugs as alternatives to potentially tainted illicit substances. In Canada, that typically means distributing hydromorphone, an opioid as powerful as heroin, to mitigate fentanyl use.
However, as I learned by interviewing more than 25 addiction experts and numerous community stakeholders (i.e. former drug users), these programs are being widely defrauded. Hydromorphone is not powerful enough to get fentanyl users high, so drug users often sell (divert) much, if not most, of their safer supply on the black market to purchase harder substances.
This has flooded some communities with diverted hydromorphone, crashing the drug’s street price by 70 to 95 per cent and creating a tide of new addictions, including among youth.
“I worked for a pretty progressive government," Sabet told me. "We ushered in the end of the term 'war on drugs' and brought in what we call the public health approach to drug policy — huge increases in treatment and recovery services, and early intervention. Mainstreaming addiction treatment into healthcare. Really seeing addiction as the health issue it is. But we never fathomed, and could never fathom, implementing ‘safer supply.’ ”
In fact, safer supply gives him “nightmares,” he said, because Americans already underwent a similar experiment in recent memory. “It’s called the prescription opioid crisis of the 2010s, and it didn’t end well," he said. "It ended catastrophically."
In the United States, prescription drug abuse became a significant problem in the late 1990s, when Purdue Pharma aggressively and deceptively marketed its then-new opioid, OxyContin.
The story of Purdue's malfeasance, and the resulting tidal wave of addiction created by its "safe" pharmaceutical opioids, has been extensively documented across a large number of court filings, journalistic exposés and books. Though some of these resources have been available since the early 2000s, public knowledge of the OxyContin crisis was substantially broadened in 2021, when investigative journalist Patrick Radden Keefe published his book, Empire of Pain, which provided, for the first time, a full chronicle of Purdue's dishonest and criminal practices.
As explained by Keefe in his book, Purdue first used low-quality qualitative research to deceive the medical community, and broader public, about how safe OxyContin was. Next they funded a network of advocacy groups to push the narrative that liberal opioid prescribing was a “compassionate” response to the “war on chronic pain.” When regulators expressed concerns about the drug, Purdue used its political connections to squelch them. Meanwhile, doctors were bribed into prescribing as much OxyContin as possible.
Almost immediately, the drug became widely abused. People became addicted to its “clean” high, creating a voracious black market that gobbled up diverted pills. Unscrupulous doctors operated “pill mills” that dispensed massive amounts of OxyContin, often at no charge to consumers, while extracting huge billings from insurers and the government.
Purdue hid internal documents that provided ample evidence of abuse and mass diversion. When investigative journalist Barry Meier exposed the truth in the early 2000s, relying on a large trove of anecdotal evidence, lawsuits against the pharmaceutical giant started pouring in — but Purdue used its arsenal of lawyers and public relations experts to harass and silence critics.
Purdue ultimately made billions by flooding communities with “safe” pharmaceutical opioids, and, in exchange, people were zombified, drained of their savings and pushed into abusing harder drugs. Hundreds of thousands of people died, directly or indirectly, because of the scheme. Though opioid prescribing was eventually clamped down upon, and Purdue has since paid billions of dollars in settlements and fines, that cannot undo this incalculable suffering.
Like many addiction physicians, Sabet sees safer supply as the second incarnation of the OxyContin crisis.
He likens the safer supply dispensaries of today to the pill mills of the recent past — both hand out highly addictive prescription opioids “like candy” with little consideration to community harms. Just as with OxyContin, safer supply advocates use manipulative language, such as questionable appeals to “compassion,” to justify reckless opioid overprescribing. “It’s a brilliant marketing term to call these drugs ‘safe’ — everyone wants something that’s safe,” Sabet said.
Just as Purdue did 20 years ago, safer supply advocates have been trying to discredit emerging evidence of abuse and diversion. “We saw (Purdue) question legitimate research on overdoses, and I see that happening here in Canada, where we see reports of parents witnessing safer supply harm their kids, and the response from the advocates is to downplay it,” Sabet said.
The former White House adviser says that he knows of, and has spoken to, several reputable researchers and physicians who, after criticizing safer supply, were told to “shut up” by their higher ups. His testimony on this matter is consistent with what over a dozen of other interviewees have told me this year — those who speak up against safer supply, including distinguished addiction physicians, worry about losing their jobs or having their clinics defunded or attacked by the government.
Low-quality qualitative studies are also once again being used to create a hollow evidence base that misleads policy-makers and the public into believing that opioid overprescribing is harmless. Worse yet, Sabet said that when you “peel back the onion a little,” it seems that these studies are often authored by activists and organizations with serious conflicts of interest — some profit handsomely from safer supply, while others receive funding from pharmaceutical companies.
Sabet is also concerned about the close relationship between Canada’s safer supply advocates and the pharmaceutical industry — another issue that has been repeatedly flagged by addiction physicians. Since the late 2010s, several prominent safer supply advocates, who once occupied influential governmental or institutional positions, have either founded or accepted high-level positions in for-profit drug companies.
“When I was in the Obama White House, what we were seeing with Big Pharma was a massive infusion of influence and money — especially towards the congressional branch,” said Sabet.
He argues that the situation in Canada today is similar to the American hydra he fought 10 years ago, even if the comparisons are not perfect. “I think this lobby has taken the legitimate pillar of harm reduction, whose interventions have a place in the continuum of drug policy, and exploited it.”
“The lack of real, unbiased research going into these reckless policies should be astounding to any academic researcher,” he added
Sabet also noted that the central conceit of safer supply, which is that increased access to legal drugs asphyxiates the black market, is “completely contradictory to the public health consensus put forth by the United Nations.”
Most studies show that, when a drug is legalized, the black market survives by undercutting legal competitors (i.e. not charging taxes, avoiding bureaucratic red tape), Sabet said. Canada’s cannabis sector is a cautionary tale — in 2022, 43 per cent of Canadian cannabis users sourced their weed from the black and grey markets, citing better quality and prices.
It should be noted that Sabet is not claiming that safer supply advocates are engaging in widespread criminal activity. During the OxyContin crisis, much of what Purdue Pharma did was legal. In many cases, the company could legally use low-quality studies to bolster acceptance of opioid overprescribing. No laws prevented the company from sponsoring an ecosystem of activists and “independent” organizations to press for cultural change, or from blocking influential regulators from immediately hopping into the private sector.
The crisis was so devastating, and tricky to tackle, precisely because of a broken regulatory and legal system.
Sabet’s contentions with safer supply advocacy are, at this point, primarily about behaviour which he believes is manipulative and unethical, but which still conforms to the law. While it may be possible that laws are being broken (and, indeed, it seems that some safer supply programs are not meeting their legally-mandated financial reporting obligations), not much can be proven at this point as the safer supply system is mostly a black box.
“We don’t know much about it,” said Sabet. “Where is the transparency? What are officials afraid of?”
While the OxyContin crisis is the most obvious comparison for safer supply, Sabet said that the playbook used by safer supply advocates is not unique to Big Pharma, and that Big Tobacco has also made extensive use of the same tactics when marketing its products.
The first step is to claim that your product is medicine — for example, tobacco was initially marketed as an asthma medication in the late 1800s, and was later sold as a remedy for throat irritation and concentration.
After your product is medicalized, you must build public trust by securing endorsements from respected members of society. After that, it is crucial to deny that your product has any harms, and to fund your own research, which distorts reality and muddies the waters. When more legitimate research contradicts your narrative, this material must be discredited — often this is done indirectly, by creating false ambiguity and arguing that there are “two sides to every coin.”
The final stage, according to Sabet, is to start “funding politicians and interest groups, and support political actors."
Though the comparison to Big Tobacco is illuminating, it also provides a sense of hope.
Sabet noted that nicotine kills more than all illegal drugs combined, and that this was made possible by “a legalized, legitimate corporate industry that could do almost whatever it wanted for 100 years.” However, over the past 40 years, policies that severely stigmatize and restrict smoking, in tandem with tectonic shifts in social attitudes, have caused nicotine consumption and addiction to drop by more than 75 per cent.
The successful fight against smoking has been “one of the greatest public health victories of our lifetime,” Sabet said. Not only has the near-vanquishment of smoking saved countless lives, it also illustrates something important: that stigmatizing and restricting drug use, not individual users, works.
The federal government seems to recognize this truth, at least when it comes to smoking. Canada mandates grotesque images on cigarette packages, and, just this week, became the first country to require warning labels on individual cigarettes.
Yet for Sabet, there is a “remarkable juxtaposition” between how Health Canada treats smoking and how it treats opioids. “We have labels on cigarette packages, and even individual cigarettes, but, at the same time, we’re whitewashing the dangers of powerful opioids. We’re saying that you can use them safely and they’re not that bad. We’re glamorizing dangerous drugs.”
For Sabet, the obvious answer is to take a stricter approach to opioids, as was done with smoking, and to increase, not reduce, stigma and barriers to consumption. He stresses, though, that this should not mean returning to the failed “War on Drugs” of the 1980s and 1990s, wherein drug use was treated predominantly as a criminal, not health-care, issue.
“We need to have a compassionate drug policy — we cannot to arrest our way out of the problem," said the ex White House adviser.
For this change to happen, though, the federal government needs to be receptive to having an “open and honest debate” about safer supply, which it currently seems to be avoiding. Sabet noted that in the Obama White House, his team made a conscious effort to listen to critics, even if they had to “clench their teeth” or “hold their noses.”
These uncomfortable conversations sometimes led to productive tweaks in policy. “I learned a lot by engaging with people of various opinions on highly contentious issues,” he said.
In contrast, Sabet said he believes the current federal and B.C. governments have engaged in a silencing campaign against apolitical doctors who want more holistic evaluations of safer supply, which he termed “astounding.”
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.