Absolutely.
The story I'm going to tell speaks directly to diversion.
I was approached by a father in the community, and he told me he had lost his son to a fentanyl overdose in the year prior. He told me that his son died while he was on my waiting list to access safe supply—he died waiting to see me, so that I could maybe save his life. I expected this father to be angry with me. I hadn't been able to see his son. However, he wasn't angry, and what he told me next surprised me even more—and this is about diversion.
He told me that his son had stayed alive longer than he had expected, because he was able to get safe supply hydromorphone tablets from a friend he was staying with, who was willing to share with him, because his friend couldn't watch him go through the profound withdrawals of fentanyl. He wanted to help him. His friend eventually stopped giving him these hydromorphone tablets, and the son went back to using fentanyl, and he died very soon after.
As a prescriber, I don't support diversion in any way at all. I expect my patients to take the medication that I prescribe them, but the discourse around diversion forgets that diversion is a signal of unmet need in the community.
We have barely 6,000 folks on safe supply across the entire country, whereas we have tens of thousands, if not a hundred thousand people who use drugs. We know from the methadone literature that most of the time people who are doing what we call “diversion” are actually helping the people in their communities survive to see the next day.