Slowly Dying: Medical heroin substitute exacerbating violence of fentanyl crisis in Nanaimo
The Bureau investigates alleged trafficking of government-issued heroin replacement pills from a safer supply clinic in British Columbia
Over the summer, I visited Nanaimo, British Columbia, to investigate a local “safer supply” clinic which several contacts had warned me about. I discovered a hotbed of criminality and violence that starkly contradicted the narratives currently peddled by Canada’s harm reduction activists.
Safer supply programs claim to reduce overdoses and deaths by distributing free pharmaceutical alternatives to potentially-tainted illicit substances. In Canada, that typically means doling out large volumes of hydromorphone, an opioid as potent as heroin, to mitigate consumption of street fentanyl.
There is significant evidence that these programs are being widely abused and that recipients regularly sell (“divert”) most of their hydromorphone onto the black market. Yet the federal and B.C. governments, which are politically invested in safer supply’s success, have insisted that this is not a significant issue.
I first learned of Nanaimo’s safer supply problems in June, after a phone call with River, a staffer at Outreach Pharmacy (to protect River’s employment The Bureau is using a pseudonym).
The pharmacy is located at 55 Victoria Road, in a building where another clinic prescribes safer supply.
Located on a steep hill overlooking the port of Nanaimo, a fast-growing city of 100,000 on the east coast of Vancouver Island, this building has become a flashpoint in a community grappling with increases in violent crime.
River explained that, before the clinic offered safer supply, no one loitered around the building. But after the program was introduced drug users started standing outside and accosting passersby with offers to sell them “dillies” (the street term for hydromorphone tablets).
“They even try to sell to us because they’re high and forget that we’re staff,” River told me.
River had rarely seen youth outside the pharmacy prior to 2020. But after safer supply, kids aged 15 and 16 started stopping by all the time, travelling from as far as Duncan (a town 40 minutes away from Nanaimo).
“You can see the high school kids at lunchtime. They go across the way and wait to buy stuff and meet people there. Like, it’s blatantly obvious, but nobody wants to do anything about it,” River said. “It’s insane. I’m overwhelmed at the difference.”
River recalled one incident where staff witnessed a teenage girl sell pills to a boy just outside the pharmacy.
The girl then asked the boy if he wanted to get involved in pill trafficking, River said. The police eventually came and asked staff to identify the pills, and then confiscated the girl’s stash of hydromorphone and oxycodone.
River alleged that, every time pharmacy staff tried to warn a certain safer supply-promoting doctor in British Columbia about their concerns, he would tell them to “shut up and fill the prescription.”
Whereas most doctors cancel a prescription when patients are found to be selling, River said the doctor “either gives more or doesn’t care.”
The situation appears to be so extreme, that River calls the doctor nothing more than a “drug dealer.”
A month after speaking with River, I decided to investigate in person.
The violent reality of safer supply in Nanaimo immediately became clear when Kevan Shaw, a former journalist, offered to guide me and provided safety advice.
He took me up to the hill where 55 Victoria Road is located and then handed me a retractable baton so I could defend myself in case of assault.
I stuffed the baton under my belt and approached the building while Shaw watched from his car.
There was a small encampment of approximately 10 people in front of the pharmacy. They were divided into two groups: a larger one predominantly made up of rough looking men and a tent, and a smaller group of two women accompanied by an older guy.
I approached a van which was parked in front of the building and asked its passengers for an interview. They seemed hostile and, declining my request, drove off shortly afterwards.
I sat down on the pavement beside the two women, cross-legged, introduced myself and asked if I could interview them. One declined and left, while the other, Tiffany, who was in her 30s, agreed to talk.
She said that she had just arrived in town earlier that day and didn’t know much about the local drug trade. She felt that nobody cared about her and that she was terrified that she would die within the next few weeks, unloved and forgotten. I told her that she was a good person and that her life mattered, but she didn’t seem to believe me.
As we spoke, a man approached us and asked if we wanted to buy a knife. He pulled back his coat to reveal several switchblades dangling from a chain on his belt.
The other encampment group – the one with dangerous-looking men – seemed like it could have more information. But I didn’t feel safe speaking with them alone. Shaw drove me to the house of Collen Middleton instead.
“I saw a knife being wielded”
Middleton lived near 55 Victoria Road and had founded the Nanaimo Area Public Safety Association last year after witnessing, first hand, the violence and disorder that permissive drug policies had wrought upon his once-peaceful neighbourhood.
He explained how shady characters, including well-known drug dealers, began to frequent the area around 55 Victoria Road after safer supply became available.
“It feels as though our neighbourhoods are just under constant intimidation and the threat of drug trafficking. And the violence that invariably comes along with that,” he said. “We see people openly wielding hunting knives on a regular basis.”
Middleton and his neighbours routinely found drug paraphernalia, including inhalation tubes and burnt tin foil wrappers, in the neighbourhood and on their property. He grew particularly concerned after finding used needles under his fence, where his two young children would sometimes play.
It was immediately apparent that safer supply clients were regularly selling their hydromorphone, according to Middleton. When he and his neighbours passed by 55 Victoria Road, he said, drug users would try to sell them “dillies.”
Discarded prescription bottles and labels also started showing up in the area.
Middleton told me they originated from Outreach Pharmacy and he found the labels were overwhelmingly for opioids prescribed by 55 Victoria Road’s safer supply doctors.
Within a short period of time, Middleton amassed more than 80 prescription labels, which he carefully catalogued as evidence.
When he shared his concerns with the pharmacy, they initially brushed him off and told him that opioid diversion was not happening.
Then they claimed, if labels were being discovered on the street, it wasn’t because of black market resale but rather, because clients were removing their labels due to mental illness or a desire for privacy.
After local media published a news story in March on Middleton’s discoveries, he learned that someone had been hired to do a daily circuit around the pharmacy to pick up discarded labels, which he felt was an attempt to hide evidence of abuse.
Middleton said that there was “still a fair number of labels around downtown Nanaimo and in south Nanaimo, but outside of the perimeter of those searches.”
After Middleton and I finished our interview, his neighbour, Gina, arrived.
A 78-year-old East Asian grandmother who lived across from 55 Victoria Road, she often expressed concern for her three grandchildren, who she was raising in her house. During our interview she struggled to keep herself from bursting into tears.
Gina explained that she no longer felt safe outside, as the arguing, fighting and violence in front of 55 Victoria Road was incessant.
Drug users defecated on her front steps and “massacred” her beloved rose bushes. She stopped gardening because she kept discovering used needles in her plants.
“I saw a knife being wielded right in front of my steps. There was a woman, a younger girl. I was out in my yard and she saw me and she just got this long, long blade and stuck it in the telephone pole,” Gina said, “so I felt that was threatening enough.”
“I wouldn’t park my car outside of my own front door because my car has been vandalized,” she continued. “I have to keep quiet because I’m scared of what they might do, because some of them are unstable.”
Gina added that, just the day before, she had witnessed a man sharpening a stick into an apparent spear.
“I don't go out my front door. I go through somebody else's driveway to get into my own house. Now, is that how I should be living? I'm 78. And I taught school for 20 years. I worked hard. I bought a house and I think oh, ‘I'm retired now. I'm going to enjoy my retirement.’ And I see this. And I don't want to just give all this away,” she said. “I worked too hard. And I have children to provide for.”
Now Gina felt trapped.
She said she couldn’t move to another neighbourhood in Nanaimo, as the threat of violence emanating from 55 Victoria Road had devalued her property, slashing her retirement nest egg.
Like Collen Middleton, Gina had also found discarded safer supply prescription labels and said she witnessed drug dealers making exchanges in front of 55 Victoria Road.
She said that these dealers often came by in trucks.
They would hop out and either go to the pharmacy themselves or purchase prescriptions from drug users in front of the building.
Gina described these suspected illegal “diversion” exchanges — drug dealers obtaining government-supplied heroin replacements for resale — as “very quick.”
I used the final hours of my reporting time in Nanaimo to interview teens at a waterfront festival.
There, I spoke with Leila, an 18-year-old who had previously abused opioids but had managed to quit two years ago.
Leila said that safer supply was “enabling” and that she hated the province’s experiment with drug decriminalization.
She found the increased public visibility of illicit substance abuse made it harder for her to stay sober. However, as she no longer used drugs, she could not say whether dillies were popular in her cohort.
Another group of five teenagers said that dillies were “everywhere” and had suddenly become popular around two years ago (roughly when safer supply became widely available in B.C.). They said that the pills would get “passed around, crushed up, snorted.”
[Editor’s note: The DEA reports hydromorphone tablets can be “crushed and dissolved in a solution (that) may be injected as a substitute for heroin.”]
And they knew kids who had “really suffered” from dilly abuse, including one 12-year-old, that they said had died from an overdose the previous year.
The teens believed that dillies are attractive to youth because they are cheap to buy and that, as the pills have an innocuous name, many peers underestimated how dangerous they are.
However, they also said that local youth are beginning to understand the risks of using hydromorphone because they’ve started to hear that “back in the olden days, dillies were heroin.”
“[Youth figure out how addictive it is] only after they try it. They all try it and then they figure it out, when they’re literally like overdosing,” one girl said. “Kids think of it as a party drug, until it’s not.”
Another added, “The rich kids from Dover (a local high school) all get their parents’ money, so they all go out and buy dillies with it. Buy dillies with their allowances.”
I asked the teens what they thought of adults in the safer supply camp who say that the hydromorphone epidemic is a myth.
They didn’t waste words, simply calling these adults clueless.
Thanks for this reporting Adam.
As a Nanaimo resident near the rich kids of North Nanaimo I also want an end to safe supply in its current iteration.
AS a former BC résident who still has family and friends there, I worry for them. It’s all contributing to the waste of what was a lovely province.
Did anyone really think about the possibilities of the "safe supply" décision?