Health Canada ignored expert advice to expand access to safe drugs for opioid users, internal documents show

It’s 11:30 in the morning on a sunny Friday in Vancouver's Mount Pleasant neighbourhood and TJ Felix has already injected enough fentanyl and methamphetamine to kill most people, but years of drug use have raised the 36-year-old’s tolerance to unthinkable heights.

The potentially deadly cocktail — known as “speedball” on the streets — is the only thing keeping Felix from experiencing the dangerous and painful symptoms of drug withdrawal.

“I would kill myself if I had to go through intense withdrawal again,” said Felix. “It’s something you avoid at any cost, and the worst, deepest level of addiction is when you're just using to avoid that."

“It’s no life at all really when it revolves just around you not being sick,” Felix said.

Felix, a two-spirit artist and musician from the Splatsin First Nation near Shuswap Lake in B.C.'s Interior, has been exposed to drugs and alcohol since they were nine years old. They moved to Vancouver in 2007 and attempted treatment several times, but it wasn't until they were part of a compassion club that provided a safe supply of heroin that they were able to stabilize.

Over several weeks, Felix allowed journalists from the fifth estate inside their life to help understand the impact a safe drug supply had for someone addicted to illicit drugs — and how that changed when their access to that supply was cut off in 2023 and they turned to fentanyl to stave off withdrawal symptoms.

The fifth estate obtained internal Health Canada reports that reveal the federal government was advised by its own experts to expand access to a greater range of safe and regulated drugs for people across Canada but that instead, at the height of the opioid overdose crisis, the government’s support for safe supply programs was watered down and eventually ended in March.

The internal documents reveal that in 2023 experts told Health Canada to support non-medical safe supply, such as legal and regulated compassion clubs. Months later, two people were arrested and charged with drug trafficking for opening a compassion club that was trying to save lives.

Since 2016, more than 53,000 people across Canada have lost their lives to a drug overdose, according to data from the Public Health Agency of Canada. An average of 18 people are dying every day. 

The majority of these deaths have been from fentanyl, a synthetic opioid 100 times more potent than morphine that is used in hospital settings and to manage chronic pain, but that is also manufactured illegally and sold on the street.

As the drug took over the street supply in 2016, physicians from Vancouver to London, Ont., began prescribing hydromorphone tablets to their patients in the hopes that a pharmaceutical drug with a predictable dose would be safer than street drugs laced with unknown quantities of the much more potent fentanyl.

Hydromorphone tablets, also known by the brand name Dilaudid, were cheap to dispense and were already familiar to people who bought street drugs — on the illicit market they are often called “dillies.” The goal of prescribing them wasn’t to get people off drugs and into treatment. It was to keep them alive and away from the toxic street supply. 

After the B.C. government developed guidelines for prescribing pharmaceutical alternatives to people with opioid use disorder, the number of clinicians prescribing hydromorphone tablets grew quickly — by late 2022, the pills were being dispensed to more than 4,000 British Columbians every month, according to surveillance data from the B.C. Centre for Disease Control.

But the program didn’t work for everyone.