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‘You don’t make a pronouncement that an intervention is ineffective or unethical based on an incomplete review of the literature and when evaluations are ongoing’

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More than 50 research scientists and clinicians have signed an open letter criticizing a report commissioned by Alberta Health which concludes it found “no evidence demonstrating benefits” of providing a safer supply of drugs.

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The letter says the report, completed by staff at Simon Fraser University’s (SFU) Center for Applied Research in Mental Health and Addiction and submitted to the province’s legislative committee examining the safe supply of drugsis “critically low quality” and not based on existing evidence.

“We must explore novel interventions with potential to save lives. Safer supply is one such intervention, and until we have high quality outcome data from safer supply evaluations, reports such as the one discussed herein are unhelpful and potentially dangerous,” the letter says.

The government-commissioned report concludes that it found no evidence demonstrating the safety and effectiveness of what it calls the “public supply of addictive drugs” and criticized publications advocating for safe supply, calling the idea to “loosely defined slogan to increase the distribution of publicly funded addictive drugs to people whose life circumstances perpetuate profound addictions.”

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Thomas Kerr, a professor at the University of British Columbia and director of research at the BC Center on Substance Use (BCCSU), told Postmedia Monday that coming to that conclusion only happens if there is an incomplete review of the data, which is what he accuses the report’s authors of doing.

Kerr said the SFU report does not adhere to best standards in part because it excluded data from numerous studies that are underway into the effectiveness of safe supply, and instead only used public studies from one database.

In cases like safe supply, where the science is still emerging, it’s considered good practice to find out if there’s preliminary or “gray” data available that’s not yet in the public domain, he said, something the report does not do.

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“Yes, we are still waiting for more robust evidence but you don’t make a pronouncement that an intervention is ineffective or unethical based on an incomplete review of the literature and when evaluations are ongoing,” he said.

The open letter says the report also does not properly analyze cost effectiveness, does not accurately portray the preferences of people who use drugs, wrongly claims that safer supply conflicts with the ethical principles of doctors, and mischaracterizes the expertise of those currently evaluating safer supply.

A measurement tool used to determine the quality of research found that the report was “critically low quality.”

In an email to Postmedia, the SFU report’s lead reviewer, Julien Somers, did not respond to specific concerns about the methodology but said the report’s authors “advocate for a sea change in Canadian addiction practices away from a reliance on medications and toward evidence-based interventions that address root causes of addiction.”

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Alberta’s committee examining safe supply has faced heavy criticism.

In February, four Alberta NDP MLAs resigned claiming the UCP was staging a “political stunt” that put politics ahead of public health. Other experts, including the BCCSU, have declined to present.

Kerr said Monday that he still thinks not participating was the right decision.

“I think it was a process set up to support a position that was already determined,” he said.

Associate minister of mental health and addiction Mike Ellis said Monday that BCCSU had a chance to present to the committee and he is “concerned about the politics for which they are playing.”

“We had over 15 hours of testimony from some of the top experts in not just North America but from around the world, yet I really saw no media coverage on this,” Ellis told reporters on his way into the legislature.

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The committee, which recently had its deadline extended until June, has heard from stakeholders including Dr. Keith Humphreys, who served in the White House Office of National Drug Control Policy under US presidents George Bush and Barack Obama, Dr. Nathaniel Day, medical lead of the Alberta Health Services Virtual Opioid Dependency Program, Edmonton police Chief Dale McFee as a representative of the Alberta Association of Chiefs of Police, Michael Shellenberger, author of the book San Fransicko: Why Progressives Ruin Cities, the Alberta Medical Association, and the Edmonton Zone Medical Staff Association’s Opioid Poisoning Committee.

— With files from Lisa Johnson

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