Across the street from a ceramics studio on Dundas Street in London, Ontario there’s an unassuming little clinic in a squat, grey building. Throughout the day people come and go from the cinderblock low-rise, attending their appointments and getting the care they need. They are accessing primary care, mental health resources, and a range of specialized programs from gender affirming care, to ongoing interventions for HIV, hepatitis, and diabetes.

For over 30 years, the London InterCommunity Health Centre (LIHC) has provided health and social services to those experiencing poverty and homelessness, as well as chronic health conditions including mental health and addictions. In 2016 the clinic added one more specialized service to its offerings: the Safer Opioid Supply (SOS) program. This made the LIHC the first clinic in Canada to prescribe medical-grade opioids to patients diagnosed with opioid use disorder.

Like all safer supply programs, the LIHC prescribes opioids to patients who have a history of complex and persistent opioid use disorder and who are resistant to other forms of treatment, including opioid agonist therapy (prescribed methadone or suboxone). People accessing this program are expected to work with the clinic’s interdisciplinary teams on medical and psychosocial goals from housing to mental health, financial security, employment, and community connection.

The impact of these services is well understood. Years of study have shown that the LIHC SOS program saves lives and steers people away from using intravenous drugs. These results are consistent with national and international studies on safer supply which show that it has consistently positive outcomes, including decreased use of unregulated fentanyl, decreased risk of overdose, reduced use of injection, increased uptake of health services, improved physical and mental health outcomes, better housing and financial stability, and decreased use of emergency services.

These findings were so promising that in 2020 the federal government starting funding similar initiatives. There are now 24 safer supply programs across Canada.

While effective, these services are not operating at scale. SOS teams carry small caseloads ranging from the dozens to the hundreds. In British Columbia, where safer supply has been the most widely adopted, only five percent of those diagnosed with opioid use disorder have access to it. Many more substance users haven’t been diagnosed with a use disorder and are therefore ineligible to even apply for these programs.

Activist groups like the Durg Users Liberation Front (DULF) have been taking action to rapidly increase the availability of safer supply to combat the shocking mortality rate associated with toxic opioids that are widely available on the streets and online. Since 2016, more than 46,000 people have died from opioid toxicity in Canada.

Despite the need for expanded access to this lifesaving service, the future of safer supply is in doubt. Federal funding for up to 21 safer supply programs may end this spring. Meanwhile, Conservative politicians at both the provincial and federal level have been campaigning against even the limited programs that do currently exist. This campaign is operating in tandem with efforts to shut down important harm reduction services like supervised consumption sites. Earlier this month, the Ford government in Ontario tabled a bill that will shutter 10 such locations the governments deems too close to schools and daycares.

These signs across Toronto this morning are making a point: @fordnation closing down supervised consumption sites doesn't make people who use drugs, let alone the toxic drug crisis, disappear — but it does ensure that using drugs will be openly forced into public space. pic.twitter.com/4f9I2zsfz0

— Diana Chan McNally (@Diana_C_McNally) November 25, 2024

For many, safer supply is not understood as a successful public health initiative in desperate need of scaling up, but rather one part of an overly permissive approach to social ills that has contributed to a broader crisis of public disorder, criminality, and homelessness. Under this framework, it is believed that people who choose to use drugs end up committing crimes, living in encampments, and making a mess of things for taxpaying citizens. For the political right, more punitive measures are required to police the drug trade and forcibly rehabilitate recalcitrant users—only by punishing drug traffickers and toughening the moral fibre of drug users, they say, can addiction and despair be broken.

This backlash is largely unsurprising. It fits a familiar pattern: a nation’s economy stops being able to provide for its people. Huge swaths of the population are thrust into precarity. The suffering of the poor and vulnerable leads them to dull their pain in whatever way they can. Governments see their citizens fall into addiction. Lawmakers respond with “tough” and “commonsense” legislation. The new laws only increase the level of desperation. The crisis worsens.

This process, the same one we are living through now, played out in full in 18th century London when an economic downturn precipitated Georgian England’s own version of the opioid epidemic—the Gin Craze. Eyewitness reports from the period are near-perfect matches for Pierre Poilievre’s breathless descriptions of Vancouver’s Downtown Eastside:

Go along the streets, and you shall see every brandy shop swarming with scandalous wretches, swearing and drinking as if they had no notion of a future state. There they get drunk by daylight, and after that run up and down the streets swearing, cursing and talking beastliness like so many devils; setting ill examples and debauching our youth in general. Nay, to such a height are they arrived in their wickedness, that in a manner, they commit lewdness in the open streets.

It is tempting to imagine that our contemporary addiction crisis is somehow worse than London’s pre-modern dalliance with gin, in no small part because heroin and fentanyl are widely understood to be so much more dangerous than alcohol, but this belief greatly underestimates the noxious qualities of booze. From 1720 to 1750 gin gripped London by the throat. The scope and scale of alcohol addiction and its related deaths were orders of magnitude beyond anything the opioid epidemic has produced in Canada. Violence, petty crime, and suicide reached epidemic proportions. The loss of life was staggering—indeed, throughout the gin craze the city of London saw more deaths than births.

Yet, in response, Britain’s Parliament passed a series of gin laws that introduced various forms of stricture and prohibitions on the gin trade. Criminalization drove the production of gin underground where a new, toxic brew emerged, one comparable to the lethal, unregulated drug supply circulating in Canada’s black markets today.

In London, the crisis worsened, but reformers and legislators remained committed to the idea that habitual alcohol consumption was somehow the fault of those who had lost themselves in their attempts to cope with deprivation. Prisons and asylums were used to discipline the wayward and the addicted. Workhouses—comparable in design and intention to modern forced treatment projects—were brought to the city in great numbers to “inure the poor to labour.” Eventually, between one and two percent of the city’s population would be detained in some 80 workhouses.

Despite the huge resources brought to bear, prohibition, prisons, and forced treatment had little effect.

After 30 years a breaking point was reached and the political class had to reconsider its approach. In 1751 Parliament passed the Tippling Act, which legalized and regulated the production and distribution of gin. This amounted to the introduction of a national safer supply policy. Soon after, the Gin Craze, with all its death and tragedy, came to an end.

This episode offers important lessons about the ways in which states can effectively respond to and end an addiction crisis. In the intervening centuries these lessons have been applied in various countries around the world.

Switzerland, for example, responded to their late 20th century heroin epidemic with a blend of harm reduction, safer supply, and robust voluntary treatment options. These policies helped reduce rates of drug use from 19 percent to three percent. Opioid-related deaths declined by 64 percent. Canada’s much smaller experiments with safer supply have seen equally impressive results in reducing fatalities.

There are, however, limits to the efficacy of these programs. Safer supply, harm reduction, and voluntary treatment do keep people alive and help them recover, but they are limited in scope and do not address the root causes of addiction. When the economy falters and huge segments of the population become immiserated, these services become overwhelmed. A rising tide of desperation can drown them in a sea of need—which is what has happened to our own harm reduction programs.

Research on the role of substances in antisocial and self-destructive behaviour, such as the famous rat park experiments, shows that when a society is able to provide for the basic needs of its people, addiction becomes a rare phenomenon. In London, for example, safer supply almost certainly reduced fatalities, but that wasn’t enough to end the Gin Craze on its own. For that, an economic recovery was necessary.

As Charles Dickens observed: “Gin drinking is a great vice in England, but wretchedness and dirt are greater and until you improve the homes of the poor, or persuade a half-famished wretch not to seek relief in the temporary oblivion of his own misery, with the pittance, which, divided among his family would furnish a morsel of bread for each, ginshops will increase in number and splendour.”

Safer supply did not end the Gin Craze and it will not end the opioid crisis. That is not its purpose. Safer supply is a public health initiative meant to keep people alive and connected to care. It is a lifeline. A tether to the supports necessary to move towards wellness. If our goal is to end the opioid epidemic, safer supply, harm reduction services, and voluntary treatment must be supplements to a larger project of reconstruction; a nation-wide effort to build an economy able to provide material wellbeing, healing, connection, and hope to all.

If right-wing leaders succeed in their efforts to abolish safer supply the only result will be more people using unregulated, toxic substances. There will be more death and more chaos, and we will be no closer to freeing our society from the horrors of addiction.

James Hardwick is a writer and community advocate. He has over ten years experience serving adults experiencing poverty and houselessness with various NGOs across the country.