Could B.C.’s safe drug supply experiment work in Washington?

Meanwhile, some activists in Vancouver believe in taking safe supply even further: making tested drugs available to all users, not just as medical treatment for substance-use disorder. In 2020, in order to curtail fatal overdoses, a group known as the Drug User Liberation Front established what it calls a “compassion club” in Vancouver’s Downtown Eastside. This club made rigorously tested versions of heroin, cocaine and methamphetamine available to users. In October founders Eris Nyx and Jeremy Kalicum were arrested for breaking B.C.’s drug laws, and the club was forced to shut down. 

A 2024 study of the compassion club published in the International Journal of Drug Policy found that among 47 clients of the club, the rate of non-fatal overdose declined by 51 percent. 

Such clubs, if they existed in Washington, would also be illegal. Palayew said they once asked an attorney involved with a harm-reduction legal project what laws would be broken if someone were to set up a similar club in Washington. “They took a pause, and then responded with: I think the question is, what laws would you not be breaking?”

“Everything just started coming into place”

Dean Wilson is a longtime drug user and activist who was instrumental in getting InSite, Vancouver’s first overdose prevention site, started in 2003. In the first days of British Columbia’s safe-supply system, he was also an early adopter.

“I was the very first person to ever buy fentanyl in the world legally,” said Wilson, who has a dark sense of humor and no qualms about saying what he thinks. He was part of an early trial of the safe-supply program that gave him injectable fentanyl. “I still have it because it’s not enough,” Wilson said, noting that medical doses are often insufficient for heavy users like himself. But he still believes it’s a crucial tool for saving the lives of certain drug users.

He points to a mother he knows who picks up safe-supply medications for her adult child, who has opioid-use disorder. “She actually rations it, so they’re not going to be dope sick but also not doing it at dinnertime,” he said. “They’re keeping their kids alive while they wait for them to get into recovery.”

BeeLee Lee’s opioid use began after she was diagnosed at age 20 with fibromyalgia, a painful chronic nerve disorder, and prescribed oxycodone. After several years of becoming dependent on prescription meds, Lee was cut off by her doctor, and turned to heroin in the Downtown Eastside around 2010. She eventually lost her job, her children went to live with her mother, and she occasionally slipped into homelessness.

She went into recovery and treatment several times, but said, “nothing ever worked right. My obsession was so intense and so real.”

“Relapse is so much a part of my story. And it’s part of a lot of people’s.”

Her beloved dog Sadie entered her life in 2019, just about the time fentanyl arrived and decimated her community. Around this time, Lee was living in a low-barrier housing unit that allowed her to keep using.

“I was surprised I didn’t die,” she said. “The staff found me many times, face down, feet blocking the door. They thought I was already deceased.”

After getting into treatment and relapsing once again, in 2020 she convinced a nurse to prescribe her safe supply. Lee’s first treatments were muscle injections of hydromorphone at a pharmacy. “Sadie and I would go twice a day,” she said. “I’d get my dose and then have to sit there for 15 minutes.”

The pandemic, however, quickly made in-person injections impossible. But since Lee had recently got a new job as a peer observer at an overdose prevention site, she was deemed stable enough to qualify for “carrys” – hydromorphone tablets she could take at home. 

“Everything just started coming into place,” Lee said. “I transitioned from a cash job into a union job and then a year went by and then two years went by and then three years went by. I go into a management job, and now I only go to the clinic twice a week.”

She’s started to reconnect with her daughters and grandchildren, though she says “It’s still a work in progress” to process the trauma of the long separation.

Lee is grateful that a nurse agreed to put her on safe supply.

“If not, I would not have my kids. I would not be working and giving back to the community. I wouldn’t be alive. And I believe that I will probably be on these medications for the rest of my life,” she said.

Treatment and 12-step programs work for some people, Lee said, but the critical issue is that so many people around her are dying. “I can’t even tell you how many times I think I see somebody I know, and then I remember: Oh no, they’re dead.”

To critics of safe supply, who say it condones drug use and should be replaced with programs that insist on abstinence, Lee said, “Here’s the thing. Not everyone’s ready. But that doesn’t mean they should be dead.”