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Study Finds DULF Reduced Overdoses by Distributing Tested Drugs

Researcher Thomas Kerr says it’s important to follow the peer-reviewed science instead of politicized opinions on safe supply.

Michelle Gamage 5 Mar 2024The Tyee

Michelle Gamage is The Tyee’s health reporter. This reporting beat is made possible by the Local Journalism Initiative.

Research first published informally by Vancouver’s Drug User Liberation Front has now been published in a peer-reviewed international journal.

DULF bought heroin, cocaine and methamphetamine from online sources known to sell purer forms of these drugs, rigorously tested the drugs and then sold them at cost to its 47 compassion club members. Members lived in Vancouver’s Downtown Eastside neighbourhood, were 19 years old and up, were members of a drug user group in Vancouver and were at high risk of overdose.

The study, published recently in the International Journal of Drug Policy, found the 47 compassion club members were less likely to die from overdose while they were able to access this safer supply.

Shortly after DULF published its preliminary findings, Vancouver police arrested and raided the workplaces and homes of DULF co-founders Eris Nyx and Jeremy Kalicum. This effectively ended the compassion club. The pair have not been charged.

“What [DULF was] doing was trying to save lives and it appears to have had that benefit,” said Thomas Kerr, a professor and head of the division of social medicine in the department of medicine at the University of British Columbia and director of research with the BC Centre on Substance Use.

Kerr produced the study alongside DULF co-founders Eris Nyx and Jeremy Kalicum, and Canada Research Chair in substance use policy and practice research Mary Clare Kennedy.

DULF was loosely formed in the spring of 2020 when Nyx and Kalicum banded together and started buying unregulated cocaine so they could test it and hand it out for free to people who were at high risk of overdose because they were accessing the unregulated drug supply.

The idea was that if people who use drugs could know the potency and combination of substances they were using, they would be less likely to overdose and die.

At that time, it was just a theory that giving people tested street drugs “wouldn’t make the sky fall down,” Kalicum told The Tyee when DULF informally published the research in October 2023.

The increasing toxicity of street drugs

In B.C. the toxicity of street drugs has been on the rise since 2012, when fentanyl first entered the unregulated supply.

Fentanyl is a synthetic opioid that is regularly used in health care in controlled settings, for example colonoscopies and surgeries where a patient is sedated for a very short period of time.

Fentanyl is more powerful than heroin and can be cheaply produced in unregulated local laboratories. As it started being added to B.C.’s street drug supply, overdose deaths started to climb. It increased the potency of street drugs and meant someone could take what they thought was their normal dose but have taken a toxic amount.

B.C. declared a public health emergency in the spring of 2016, after 529 people died from overdose in 2015.

Tragically, the street drug supply has only grown more toxic since then.

Fentanyl analogues, which can be hundreds of times more powerful than fentanyl (and 10,000 times more potent than morphine), and other drug classes like benzodiazepines and xylazine have been added to the supply too. Benzodiazepines can make the effects of opioids more powerful, which can put people at a higher risk of overdosing.

Overdose fatalities were nearly five times higher last year than in 2015, reaching 2,539 deaths.

B.C. has had a provincial safer supply program since March 2020, in which people who use unregulated opioids can talk to their doctor about getting a prescription for pharmaceutical-grade opioids. But only about five per cent of the estimated 100,000 people with opioid use disorder in B.C. are accessing this program.

Opioid use disorder is defined by the BC Centre on Substance Use as a chronic relapsing illness associated with high risk of death.

B.C.’s chief coroner and provincial health officer have both publicly called for the province to look at expanding how many people can access safer supply by exploring non-medical models, such as compassion clubs.

The harm reduction initiative of distributing naloxone kits, which can temporarily reverse an opioid overdose, is becoming less effective because more naloxone is required to counteract the more powerful opioids, and naloxone doesn’t reverse benzodiazepine toxicity.

This and many other factors such as poverty and homelessness are feeding into a catastrophic loss of life due to unregulated drug poisonings, with annual death counts steadily increasing since 2019. Unregulated drugs are now the leading cause of death for everyone in B.C. aged 10 to 59, according to the BC Coroners Service.

This is the horror Nyx, a harm reduction worker at the Downtown Eastside SRO Collaborative and a musician, and Kalicum, a drug-checking technician at Substance, a drug-checking project on Vancouver Island, were staring down when they decided to start buying and supplying people with a tested supply of drugs.

Peer-reviewed science over politics

While DULF was occasionally handing out tested substances, it was also applying to the federal government for an exemption to the Controlled Drugs and Substances Act. In August 2022, DULF was informed that it would not be given this exemption.

In that same month, 190 British Columbians died from toxic overdose, and B.C. had one of the highest per capita unregulated drug death rates in the world, with 44.8 deaths per 100,000, according to the study. The Downtown Eastside had 557 deaths per 100,000, and the rest of Canada had 19.3 per 100,000. Scotland, which has one of the highest toxic drug death rates in Europe, had 16.8 deaths per 100,000 from 2018 to 2022.

And so Nyx and Kalicum kicked off an unsanctioned compassion club and invited Kerr and Kennedy to help with the research.

“As far as we know there has never been a compassion club of this kind anywhere in the world,” Kerr said.

Club members could purchase at cost up to 14 grams of cocaine, heroin or methamphetamine per week that had been tested using four different methods to ensure quality and check for potentially fatal contaminants. The DULF storefront, located in the DTES, was open four days a week for a total of 24 hours, and included an overdose prevention site.

Data for the research was collected by surveying the 47 compassion club members every three months between August 2022 and October 2023. Survey questions were adapted from several DTES studies and administered by trained research assistants.

With an average of five surveys done by each participant, the study collected 225 observations and a collective 44.4 years of data. The majority (62 per cent) identified as male and white, and 49 per cent as Indigenous. Participants could choose multiple ethnicities if more than one applied. Most (78 per cent) had also been incarcerated and nearly half said they were unstably housed.

During the study, almost half of the participants experienced at least one non-fatal overdose and 38 per cent had an overdose where naloxone was administered. None of these overdoses happened at the DULF club. Being enrolled in the compassion club reduced a participant’s odds of any type of non-fatal overdose and non-fatal overdose involving naloxone administration.

Forty-seven participants who began the study completed the study, meaning none experienced a fatal overdose during the study period. One person enrolled in the study but died before they could access the compassion club.

This suggests compassion clubs can help reduce the pressure on overwhelmed health-care systems, the study notes. A similar 2022 study from Ontario also found that when people can access safer supply, they require fewer hospital visits, saving on health-care costs.

At the rate people are dying, Kerr said, “it’s obvious what we’re doing is not enough.”

Kerr is critical of the recovery and treatment industry because treatment is often offered by private providers with financial interests. Opioid agonist therapy is great if you can keep people in the program, but the majority stop using it before it can have long-lasting positive impacts, he added. And people struggle to access safer supply because doctors are hesitant to prescribe, people can’t access a doctor or the medications or hours don’t work for them.

“We need innovation in this area, and I think this was a particularly potent intervention,” he said.

Compassion clubs are “a way of elevating drug checking up the supply chain and ensuring a safer supply for people until we get to where we need to be, which is a fully regulated system just like we have for alcohol,” Kerr said.

He notes how all other consumables, such as food, alcohol and cigarettes, are regulated to promote consumer safety.

DULF was “a consumer safety initiative in the midst of the worst public health crisis in recent history,” he said.

Drug policy has gotten very politicized recently, and it’s important for everyone to listen to peer-reviewed science instead of “armchair academics,” Kerr said. Other Canadian researchers have offered similar warnings.

You can identify these “armchair academics” because they mainly publish on social media, Kerr said.

“It’s easier to offer a critique via Twitter than it is to submit something at a journal and have five anonymous reviewers determine whether it’s worthy of publication and dissemination,” he added.

As an example, he pointed to a report commissioned by the Alberta Health Ministry in 2022 that found there were no documented benefits of safer supply.

More than 50 research scientists, doctors and people who use drugs said the report was “remarkably low quality and would probably not have been published in a peer-reviewed journal,” Kerr said. “But still, it gets cited by policymakers as somehow proof that safe supply doesn’t work.”  [Tyee]

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