Thank you and good afternoon.
I am Dr. Andrea Sereda and I am a physician working at the London InterCommunity Health Centre. I have 14 years of frontline experience providing primary health care to about 2,000 people living in homelessness and people who use drugs.
As an emergency room doctor, I have resuscitated patients who have died due to overdose and I have treated debilitating infections related to the toxic drug supply.
I am also the lead physician for Canada's longest-running safe supply program, which has been in operation in London since 2016.
There are many different models of safe supply, but today I am going to speak about medicalized, prescribed safe supply. The goal of prescribed safe supply is to convert people who are using an unregulated, illegal, street-based supply of fentanyl to a regulated, legal, prescribed alternative opioid of known dose and known purity.
This goal is really important to understand in our discussions, because the reason unregulated fentanyl is so deadly is not just that the fentanyl molecule is so potent. We use highly potent pharmaceutical fentanyl safely in emergency rooms, ICUs and ORs across the country every single day. Illicit fentanyl is so deadly because its composition and potency are so unpredictable. People who use drugs don't know if the piece of fentanyl they have is 5% fentanyl or 70% fentanyl. It's this unpredictable variability in illicit fentanyl that is causing the devastating overdose crisis we see in Canada.
I explain the problem of fentanyl variability to my patients by using a metaphor that compares fentanyl batches to a batch of chocolate chip cookie dough. If you don't mix the cookie dough well enough, you can end up with a cookie that has two chocolate chips or a cookie that has 20 chocolate chips. These metaphorical cookies are from the same batch, but they have wildly different chocolate potencies when you bite into them. The problem with illicit fentanyl is not knowing whether you have two fentanyl chocolate chips or 20 fentanyl chocolate chips.
By providing people with a prescribed safer supply of an opioid of known dose and known purity, they always get the same standard, safe supply cookie of 10 chocolate chips. People know exactly what dose of opioids they are getting. Therefore, they can be much safer when using them.
Safe supply doctors like myself see safe supply as one part of a spectrum of solutions to the fentanyl crisis. Safe supply clinicians support their patients along the entire continuum of treatment, from abstinence to the prescription of medications like buprenorphine and sublocade, to residential treatment, if that is the person's goal. Within prescribed safe supply programs, we provide the full spectrum of treatment for people with opioid use disorder.
Safe supply is not a wild west of overprescribing, as some have described it. We prescribe safe supply very carefully to a group of people with highly complex medical and social needs that have not been met in other addiction treatment models.
To be eligible for prescribed safe supply in the first place, people need to have experienced—