People who use drugs are at elevated risk of death due to the toxic illicit drug supply. Providing easy access to a supply of safe, clean substances may reduce overdose deaths, decrease harms associated with substance use, and improve users’ trust in addiction care.
Safer Alternatives for Emergency Response (SAFER) is a low-barrier, flexible safe supply program that provides several replacement options for people who use illicit drugs, including fentanyl, and is integrated with other healthcare and social services.
In this episode, Drs. Omole and Bigham speak with two physicians who work with the SAFER initiative. Dr. Sukhpreet Klaire is the lead author of the article in CMAJ entitled Low-Barrier, Flexible Safe Supply to Prevent Overdose. He is an addiction medicine specialist working in Vancouver. Dr. Melanie van Soeren is a family physician and addiction medicine specialist in Vancouver.
Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.
You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole
X (in English): @CMAJ
X (en français): @JAMC
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Instagram: @CMAJ.ca
The CMAJ Podcast is produced by PodCraft Productions
People who use drugs are at elevated risk of death due to the toxic illicit drug supply. Providing easy access to a supply of safe, clean substances may reduce overdose deaths, decrease harms associated with substance use, and improve users’ trust in addiction care.
Safer Alternatives for Emergency Response (SAFER) is a low-barrier, flexible safe supply program that provides several replacement options for people who use illicit drugs, including fentanyl, and is integrated with other healthcare and social services.
In this episode, Drs. Omole and Bigham speak with two physicians who work with the SAFER initiative. Dr. Sukhpreet Klaire is the lead author of the article in CMAJ entitled Low-Barrier, Flexible Safe Supply to Prevent Overdose. He is an addiction medicine specialist working in Vancouver. Dr. Melanie van Soeren is a family physician and addiction medicine specialist in Vancouver.
Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.
You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole
X (in English): @CMAJ
X (en français): @JAMC
Facebook
Instagram: @CMAJ.ca
The CMAJ Podcast is produced by PodCraft Productions
Dr. Mojola Omole: Hi. I'm Mojola Omole.
Dr. Blair Bigham: And I'm Blair Bigham. This is the CMAJ podcast.
Dr. Mojola Omole: So today, Blair, we are talking about a practice innovation paper out of the CMAJ that is, I think, could be revolutionary when we're talking about addiction medicine. So this paper talks about a program in the east side of Vancouver that is about providing people who use substances a safe, flexible supply to prevent overdose. So basically, they are a group of community workers, physicians and nurses who have developed a program for people who use drugs frequently to be able to provide them with a safe supply of whether that is fentanyl or hydromorphone. And this is divorced from the concept of, you know, treating addictions, but instead it's trying to prevent overdoses by giving them a safe supply of these drugs versus them getting it on the streets, which is which has been shown to have contaminants in it, leading to the higher rates of overdose and death that we've seen in recent years with people who use substances.
Dr. Blair Bigham: It's going to be a really interesting discussion. We've got Dr. Sukhpreet Klaire. He's the lead author of Low Barrier Flexible Safe Supply to Prevent Overdose. We also have another physician, Dr. Melanie Van Soeren. She's a family doc and an addiction medicine specialist who works with Dr. Klaire in the program that's been described in the manuscript. You know Jola, in the emergency department, it's been nonstop for years and years and years, these overdoses that are coming in and it just feels like such a revolving door. We give Narcan, they wake up, they decide to leave. We can make referrals to addictions, medicine. Sometimes they go unfilled and we see those people again and again. And it's really heartbreaking. And, you know, for years there was sort of this debate, I think, within emergency medicine and certainly policing circles about how can you sort of clean up the supply and how can you prevent some of these contaminated drugs or drugs of variable potency from getting to the streets in the first place? And while, that sounds like a great area to target, it's been a decade and we have thousands of deaths from overdoses every year just in Canada.
Dr. Mojola Omole: And this is why this paper is really could be revolutionary because it really just tackles that head-on. Right? And it's really changing the way we view people who use substances instead of treating it as a crime, which is what we do in Canada and most countries. We criminalize a health issue. This is actually treating it as if, okay, you have hypertension, instead you have a substance dependence and treating them from preventing them from dying from it is what this program is doing.
Dr. Blair Bigham: Absolutely. Let's jump right into it.
Dr. Mojola Omole: Dr. Sukhpreet Klaire is the lead author of the article in CMAJ titled Low Barrier Flexible Safe Supply To Prevent Overdose. He's an addiction medicine specialist working in the SAFER Program in Vancouver. And Dr. Melanie van Soeren is a family physician who also works in the SAFER program. Thank you both for joining us. Sukhpreet, let's just start off, I said both of you work with the SAFER program. Can you just describe to us what the program is?
Dr. Sukhpreet Klaire: The program itself is, essentially, a safe supply program. So the intent is to provide alternatives to the unregulated drug supply to people who use drugs, with the goal of reducing the harms from the unregulated drug supply. The most notable - or the most…the one that we focus on and think about most - is preventing the risk of overdose from a drug supply that is variable in its contents and unpredictable in its composition. So essentially, we are attempting to identify people who are at risk of harms of using substances, particularly using substances that they may not know what the contents are and provide them a known quantity and known alternative to those substances under the sort of understanding that people will continue to use drugs and that people are interested in using drugs, and we want to make sure that they can be safe in doing so.
Dr. Mojola Omole: So when you say using drugs, like what are we talking about? What is available for clients at the SAFER program?
Dr. Sukhpreet Klaire: Primarily, right now, we're thinking of two different classes of substances. So the main one is opioids. So some of the medications that are available and alternatives are available are powdered fentanyl, sufentanil, which is another opioid, and hydromorphone. And then when we're thinking about stimulants, people are using stimulants, there are alternatives, prescribed alternatives, like dextroamphetamine, and methylphenidate. Those are the current ones.
Dr. Mojola Omole: And it's not just the drug supply that's available for the clients. Are there any other services available for clients when they come to the program?
Dr. Sukhpreet Klaire: Yeah. So the idea with the sort of physical space and to have a sort of a program structure around it is to provide a few other things. The main one that is very visibly identifiable when people come in is that the site itself serves as an overdose prevention site. So a location where people can use drugs in a monitored setting and be around others. Recognizing that even when there is a known quantity of a substance being used, there is still a risk of potentially using too much and suffering an overdose. And being in a space that is safe to use the substances is really important. So the one is that the space itself serves as an overdose prevention site and provides that harm reduction service. In conjunction with that the space also provides sterile supplies for use of substances, can provide harm reduction education around how to use substances in a safe way and can also provide access. The second part of this is that it can also provide access and direct availability to primary care resources, like actually accessing primary care and those basic medical needs in addition to resources like how to access housing, how to access financial supports, those sort of psychosocial and social interventions that we know are important and beneficial for this population.
Dr. Mojola Omole: Melanie, could you walk me, through, so you have someone who uses opioids on a regular basis, how does it work? They come in and then what happens?
Dr. Melanie van Soeren: So what happens is we generally have two pools of clients. The clients are either coming from our clinic, so they've already been cared for by PHS for a number of years. Many of them have, in the context of the fentanyl crisis, become destabilized. There are folks who've maybe been using opioids since the eighties or nineties and perhaps are even stable on methadone or Suboxone or Kadian in the past. And so these are folks that we know very well and we know their treatment history and we are assessing them in that context, knowing what has worked in the past and what's no longer working. And then we're basically problem solving to try to keep them alive, essentially. So those are the folks that we know. And then the other folks are referred to us from other clinics, frequently from clinics within the Downtown Eastside: the community health centers and other facilities that maybe don't have these more novel therapies available. And we do an assessment. We do an intake, which involves a thorough addictions history, as well as a primary care review, and determine what the most appropriate therapy for them might be. And that's usually done, obviously, with their input and figuring out what it is they want to be using, as well as through discussion with their primary care provider to ensure that this aligns with the overall treatment plan for that individual.
Dr. Mojola Omole: And do they have to use a substance on site or do they take it with them?
Dr. Melanie van Soeren: So the answer is yes to both. And we're working on this because, you know, the example that I always give people is most of us consume some form of mind altering substance, whether it is alcohol or cannabis or some other substance. And we generally don't want to be using that in a clinical setting. We want to be using that at home or at a bar or with friends. And so asking our clients to be always coming to a medicalized facility to be using these substances that they're using really doesn't work for a lot of people. For some it totally does, but not for all. And so we're looking at ways to, when people are using on site, make that site not feel so medicalised and make it feel like a safe and comfortable place, that's really just a community space. And then we're also looking at ways that people can take drugs home and use them the way they want to use them without us breathing down their necks. And so that's where a program called the Enhanced Access Program comes in. And we're looking at ways for folks to be able to purchase these substances, specifically the fentanyl powder, in a dose that has been titrated up to to determine what's a safe dose for them, a dose that is not causing any significant sedation, certainly not causing overdose. And then they would be given a prescription just like I would get a prescription for a Ventolin inhaler or for cetirizine. And they take that to the pharmacy, which is our pharmacy, it's a pharmacy that we run all of our programs through, and they would buy it and then take it home and use it in the way that they want, knowing exactly what their dose is so that every time they can be using the same thing in a safe way.
Dr. Mojola Omole: And I'm assuming it's not cost prohibitive. It's something that's accessible?
Dr. Melanie van Soeren: Yeah, exactly. So it's not cost prohibitive. It's on par with what they would be paying if they were buying from their drug dealer. And we're working on exactly what that looks like, because one of the really fascinating parts of this program is we're actually getting an idea of the potency of the fentanyl that is being used by our clients when they're purchasing from the unregulated market. We really had no idea. People tell us, I use a point or I use three points at a time, or I use a gram or an eight ball a day. And we really don't know what that means and how much fentanyl was actually in that, because these are all terms that existed when describing heroin. And when they say a point, that means 0.1 of a gram. And they're, of course, not using 0.1 of a gram of pure fentanyl, but they're still using a lot. And we just wanted to know what that actually was. And so we've figured that out, which has been a really cool outcome of this early phase.
Dr. Mojola Omole: What did you guys find out?
Dr. Melanie van Soeren: So, it's about 5000 micrograms of fentanyl is one point.
Dr. Mojola Omole: OK I'm a surgeon, so I don't know what that means, can you explain?
Dr. Melanie van Soeren: 100%. So I do obstetrics care and for any folks who work in Emerg, obstetrics or anesthetists would get this but other folks might not. So for example in labour when somebody is nine centimetres dilated and you just need to get them to the point where they're able to push, you might give them 50 to 100 micrograms of fentanyl. And we're giving people 5000 micrograms of fentanyl and they will just sit there and be talking to you like you've given them nothing. And so people are actually probably going to need more, but they tell us this feels like about a point that I buy on the street.
Dr. Mojola Omole: Wow.
Dr. Blair Bigham: How long have you guys been able to distribute a regulated supply? Is that something that's been pretty new or has that been going on for some time?
Dr. Sukhpreet Klaire: Yeah. I mean, in some ways this has been in evolution over the last few years. So I think that when we go look back to one of our first programs that we ran before, SAFER existed in its current form, we ran a tablet distribution program where patients would come in and receive tablets of hydromorphone and use them on site. And that was before the COVID pandemic. I think that we started that in February 2019 or so, but that was a very specific program for patients who had not responded or were still continuing to use, despite being on treatment doses of sort of our evidence based forms of opioid agonist therapy. And they were coming in and receiving these fairly small doses of hydromorphone that they could either inject or take orally in addition to their OAT. And that was in a pretty, it was still in a non-clinical space. But I think it was a bit of a difference compared to what SAFER is now. And that was one of our examples of an early program that we ran. And then during the pandemic itself in British Columbia, there was a sort of movement and push to prescribe safer alternatives to the drug supply through prescribers like essentially across the province. And there was a variable uptick in that. But certainly, in Vancouver, there was quite a lot of it. So patients were receiving things like hydromorphone tablets that they could take home and use and they were being prescribed them through either their primary care provider or their addiction provider or what have you.
Dr. Blair Bigham: What about the pandemic could push this forward? How did the pandemic accelerate this work?
Dr. Sukhpreet Klaire: I mean, I think there were a few things. One was that we recognized that for our patients, especially those who are using large quantities of drugs, their patterns of substance use involve a lot of interpersonal contact. So maybe we conceptualize if we're going to drink alcohol, we would go to the store and buy it. And then we might actually have a supply that would last us for a fairly long time. But one thing we were seeing, particularly in those who were potentially most vulnerable to COVID infection, was that there was a lot of human interaction, there was a lot of community interaction, and that was one part of it that that really prompted this conversation around whether reducing those interactions could be potentially beneficial from an infectious disease standpoint. But while I wasn't directly involved in the creation of that work, I do also want to say that it was potentially taking advantage of a bit of an opportunity to recognize that we also need to confront this growing rate of overdose death that was continuing across the province. And I think there was a part of it that was driven by the infectious disease standpoint. But I think a large part of it was also, like, this is potentially a chance to do something that really has been felt to be necessary for a long time.
Dr. Blair Bigham: What type of criticism have you had or what have the critics tried to put up to block some of your programs? And how have you overcome that?
Dr. Sukhpreet Klaire: Yeah, I mean, the main criticism that I think comes about and - I think that this is something that's been applied to a number of previous harm reduction sort of initiatives, whether it be distribution of clean needles or supervised consumption sites - I think something that comes about and is commonly a knee jerk reaction is that what we're doing or what we're trying to provide in a safe supply of substances is going to continue to perpetuate substance use and that it may be contrary to people accessing treatment and that it may prevent people from accessing treatment. I think the worst example is when people think that the sort of fear of dying of fentanyl may motivate people to stop using, and therefore we are taking away that fear. And so all those sort of things, I think, ultimately, are, to be blunt, just wrong. What we see clinically and what we see from our sort of evidence base about these things is that those things are not true. In fact, by creating a low barrier option for people to access substances, then they are able to continue to be alive to access treatment. And ultimately we are there to help people get what they need in that moment. And if in that moment they are not seeking out to stop using substances, then it's very important that we be there to support them and ensure that they feel comfortable coming to us when they do want to access that sort of point, if they should want to. I think that's the main criticism I really think of and that comes to mind. I think for a lot of people in the addiction medical community, it can even be something that comes into their minds, whether it makes sense to continue supporting these things or to support these interventions.
Dr. Mojola Omole: Since you guys are only open from like 8 to 4, is it possible that you're just increasing the supply of substances in the market because they can, after 4:00, go and get unregulated substances? What would you say to that, that, you know, you're just providing more, Melanie?
Dr. Melanie van Soeren: Sure. So people absolutely do need their substance. And we would love to be able to provide that for folks - to provide all of the substance that they need so that they're not having to buy an unregulated supply. But as exists in all areas of health care, we just don't have the staffing to be able to do that. And so that's the only reason why the hours are what they are. Not because drug use stops after 4 p.m.. That said, most of our patients are also on OAT and so a lot of them will take their methadone or Kadian later in the day. And so then that kind of helps them through the night with any withdrawal symptoms that might crop up and they might still be using, but they're using a lot less than they were before. And that's the feedback that we're hearing from patients is, "Ya, I'm still using, but instead of using ten points or a gram a day, I'm now coming here three or four times a day so that all of my withdrawal symptoms are managed during the day. And then I'm only having to chip," is the term they use, "I'm only having to use small amounts, so chip away at night." And so they might be using one or two points, which is a huge reduction. And so again, that's just the philosophy around harm reduction. You're not going to be able to completely eliminate the harm. You're just going to try to reduce it, and you're going to try to delay any harms as well.
Dr. Blair Bigham: I'm curious, do people report that the regulated substance gives them a different high or better or different control of withdrawal symptoms compared to unregulated substances?
Dr. Melanie van Soeren: It's such a good question. So our, what is in the capsules that we're providing patients is fentanyl, there's caffeine, and there's sugar. We're creating different formulations and kind of playing around with it to make sure that it's just right and getting feedback from patients constantly. Initially, they told us there was too much caffeine, so we cut down the amount of caffeine that's in it. And then we've had issues with patients that were trying to smoke it and that it burns black and people don't like that. And so we're working on switching it. We're adjusting the formulation to meet the needs of our patients, and we're continuously requesting feedback. And one thing that I just - I was speaking with one of our amazing nurses, our nurse manager, Nicole, this morning to ask about how things are going this week, and she said “somebody told me today that they had the warm blanket feeling.” And so this might not be familiar to folks who don't work in addictions medicine. But people always talk about this feeling of a warm blanket when they have used - typically, they talk about that with heroin. And that people often talk about as being what they're really looking for, this sensation of, like, warmth and comfort and calm, and that they're starting to now experience that with the right doses of the substance we're providing. So that's exactly what we're looking for. We want this to feel as close to the high that people are looking for so that they use our drugs and not an unregulated supply.
Dr. Blair Bigham: I'm just imagining like a Breaking Bad episode and you guys are coming in as this alternate market, a safer market. I'm just curious, is there like… Like, the drug dealers aren't just going to pack up and go away. Right? Like they're still out there to make money. I'm just curious, have you guys faced any threats, any competition from, like, the street dealers who are, like, “whoa, what is this new business??
Dr. Mojola Omole: They can give you a better deal?
Dr. Blair Bigham: I'm just curious. This is pretty complicated stuff. I don't know. I imagine your clients might still feel really pressured to continue purchasing on the streets. What are the consequences there?
Dr. Sukhpreet Klaire: Yeah, I don't know that I've yet been threatened, but I'm certainly not going to walk around with advertising saying that's what I'm doing. I think the reality, when we think of the scale of of the problem and also the scale of substance use, is that we're still early Breaking Bad days. We're not in the later seasons in terms of scale just yet. But I think it does speak to the fact that we're also going to ultimately have a challenge in fixing or addressing some of the issues with the unregulated drug supply in this format. And that, while we want our program to address a need, we recognize that policy change at the larger level, whether that looks like decriminalization of substances to reduce the harms associated with their use, or legalization or availability of substances in a different avenue, that is not so, let's say, small scale and community-run, that ultimately those are going to be the things that really, I think, make the impact on a larger level. And we're, I think, demonstrating an example that hopefully it can work and it can be delivered. And, given the urgency of the problem, we need to deliver it now. But I'm hoping that ultimately the things that make a great deal of change do so in a way that take our intensity off of it. And we don't have to worry about anyone coming after us.
Dr. Mojola Omole: And what about the local police service? How have they reacted to the work that you guys have done?
Dr. Melanie van Soeren: They actually took a tour of the site just two weeks ago. Yeah. They're very supportive. The mayor's very supportive. They took a tour of the site in part to get a better understanding of what it is we're doing. But they also wanted to look at our capsules so that they know what to look for, if they do confiscate anything, just to be able to distinguish what our capsules look like versus other substances in the unregulated markets. So they're currently very supportive and I can speak as well to the question around threats and safety because it's something I ask our nurses all the time, "Do you feel safe coming here? Is this something that you feel is putting you at risk, especially with the potential for selling large amounts?" And, so far, there haven't been any concerns around safety. And I think, in part, my suspicion anyways, is that we're really well respected within the community. So there's a lot of folks who are looking out for us. And we work with mental health workers, we work with peer navigators and peer workers who are really who are part of the community and who help add credibility to what we're doing. We're not just folks dropping into the community without input, without knowledge from people with lived experience. They are actively involved in designing these programs. And so I think we're pretty well accepted in the Downtown Eastside.
Dr. Mojola Omole: Is there an experience or a client that sticks out to you that made you think about joining this program or being part of this program?
Dr. Sukhpreet Klaire: The examples of patients that come to mind when I think about why I want to continue this work are the ones who were doing really well from a substance use standpoint, but had a brief lapse or used a small amount of fentanyl and then weren't alive to continue to go on that journey. And that always reminds me about how important it is to be assisting people in all steps of their journey. That's the main person that comes to mind for me.
Dr. Mojola Omole: What is the evidence that this is working?
Dr. Sukhpreet Klaire: Yeah, I mean, it's early days, so I don't think that we have that sort of robust level of formal evidence that we want to support it or to decide and tell us that certain things aren't working and are not effective. You know, there have been studies looking at some of the previous sort of iterations of safe supply or different forms of injectable treatment that have shown efficacy in terms of reduction in people's use of illicit substances and engagement with care. And that specifically looking at things like injectable hydromorphone and injectable diacetyl morphine. So those were typically delivered in more of a sort of treatment and medicalized fashion where people were coming in on a very regular basis and getting those substances. But some of that evidence, I think, can be extrapolated to some of the programs that we're running and some of the things that can be applied to SAFER are that for people who are not benefiting from oral OAT alone, there may be benefit in alternative options. I think we can also extrapolate some of the evidence from other harm reduction interventions that we're co-housing and co-delivering to suggest that people are more likely to engage in treatment and engage in reducing substance use long term if they are provided with a safe and managed approach to their substance use. And we have this informal feedback from our clients and from providers that what we're doing seems to be meeting their needs and the way that currently available options aren't. What we're trying to do in order to answer some of the unanswered questions is a robust evaluation structure, both in a quantitative form and also through qualitative interviews with participants that are planned for the next few years, to answer some of these unanswered questions about whether we're having unintended harms both to the community or on an individual level, whether we're seeing changes in health care system utilization or other benefits or harms from an individual level and the sort of cost-effectiveness of the intervention as well.
Dr. Mojola Omole: So this is a very narrow program located in the Downtown Eastside of Vancouver. What's the takeaway for the general population of physicians?
Dr. Melanie van Soeren: What we're trying to do is find that evidence required to determine if this is an intervention that can be used elsewhere. As we've discussed, this is an issue that we are working on within the Downtown Eastside, but we know that the opioid overdose crisis is happening all over British Columbia and now all over Canada as well. It's certainly spreading east. And so we need interventions that are straightforward, that are safe and that are effective. And we think we've got the straightforward piece figured out with the idea of the enhanced access program where people could be titrated to a fentanyl dose that is appropriate for them and then be given a prescription and take that to specific pharmacies, of course. This is not something that will be available at every pharmacy. But to have a site where they could go and purchase this substance and take it home and that's how we can make it scalable and that's how we can also help people exit the market that they're having to currently contend with, which involves often people needing to engage in theft, to engage in sex work, and to do other things that they might not want to be doing to access substances. So we're trying to help people exit that and to not have to be involved with dealers and that sort of thing. So that's a piece of it for sure. In terms of the safety and the efficacy, those are the pieces that we're working on right now. So I think we really need to demonstrate that it is safe and effective before we can truly scale up this approach to be able to use in northern B.C. or in Manitoba. But I think that this is the closest we've gotten over the course of this epidemic to finding something that could work because we're basically giving people exactly what it is they're telling us they need rather than trying to substitute with something that we've been showing over the past six years is not meeting their needs.
Dr. Mojola Omole: Awesome. Thank you very much for joining us. Dr. Sukhpreet Clair and Dr. Melanie Van Doren both work in the SAFER program, Vancouver as addiction medicine specialists. And the paper is called Low barrier, flexible, safe supply to prevent overdose in the CMAJ. Thanks, guys.
Dr. Melanie van Soeren: Thank you.
Dr. Sukhpreet Klaire: Thank you.
Dr. Blair Bigham: So Jola, 25,000 deaths between 2016 and 2021 from overdoses just in Canada alone. We know that this problem is even bigger in the United States and elsewhere in the world. This seems this seems radical in some ways, but also like just like the next step, right? You can't get treatment if you're dead. What do you think?
Dr. Mojola Omole: And I think it's common sense. And I'm a bit like I in general am a harm reductionist. And so even if it's not about people getting treatment, it's that, even if you are someone who uses substances, you still have value, like, we still want you around. And so if this is a way to keep you around, if this is a way for you to be able to be whether it's a parent or have a job or whatever you're doing to feel fulfilled in life. If this is the way to keep you around to do that, I'm all for it.
Dr. Blair Bigham: Absolutely. In terms of this expanding Jola, I don't know. I mean, the scientists in me is, like, show me the data. But the emerg doc in me is like, where was this five years ago? What do you think?
Dr. Mojola Omole: I think I'm in the camp of, I'm not always data driven. And so I see the value in this program, but I 100% agree that there needs to be more data for people to get on board, for us to be able to have it to be scalable. So I think for now, I'm excited that they have a program like this. And I also think it's very helpful when we're talking about public policy, about decriminalizing substance use. I think if you show that these kinds of programs work, this really will incentivize decriminalizing substance use.
Dr. Blair Bigham: I think I'm on the same page as you, but I remember the battles that went on around safe injection sites over the last 10 to 15 years and how political that became for so many communities. And I hope that when we do have the scientific evidence that will hopefully back up some solution to this national crisis we have that's killing thousands of people a year, I hope it's apolitical. I hope it is outcomes driven, health driven, and that we're able to really get this crisis under control.
Dr. Mojola Omole: It goes back to depolicing health care. This is a health care issue. This is not a policing issue. And oftentimes we view substance use from a policing aspect and from a criminal aspect instead of viewing it as this is someone who has a different chemical makeup in their brain and so they need a substance. And you don't deprive someone of needing their daily cigarettes or their daily, you know, alcohol use. But in this situation, we do. So I think, you know, if we keep that in mind and we keep it as a health first and not a police first, hopefully there wouldn't be as much pushback. Or maybe we've evolved as a society in Canada that we start having compassion for our fellow citizens.
Dr. Blair Bigham: That's it for this week on the CMAJ podcast. Please remember to like and share our podcast wherever you download your audio. I'm Blair Bigham.
Dr. Mojola Omole: I'm Mojola Omole. And until next time, be well.