Two of British Columbia’s key harm reduction programs were ineffectively implemented and beset by challenges that affected service quality and accessibility, according to the province’s Auditor-General.
A report by Michael Pickup released Tuesday found that the prescribing of pharmaceutical alternatives to the toxic drug supply, an intervention commonly referred to as safer supply, was limited by prescriber availability, the appropriateness of medications offered and geographic inequity. The contentious program also lacked the public reporting needed to build public trust, he said.
Meanwhile, overdose prevention and supervised consumption services in B.C. were impeded by staffing shortages and pushback from municipalities, while operational guidance lacked minimum service standards and didn’t always reflect consultations with health authorities and users, Mr. Pickup said.
“Significant deficiencies” were found in the provincewide implementation of both programs, the Auditor-General told a news conference on Tuesday.
“A prominent theme runs through both of these audits, and that is that the Ministry of Mental Health and Addictions, and the Ministry of Health, have not effectively addressed the many challenges and barriers facing each program.”
The report included seven recommendations to the two ministries, all of which the ministries accepted.
The two independent audits come eight years after B.C. declared a public-health emergency in response to skyrocketing drug deaths from an increasingly toxic illicit supply. More than 14,000 people in the province have died since 2016.
The obstacles to implementing safer supply programs identified by the audit are similar to those flagged in a recent review by Provincial Health Officer Bonnie Henry. They include a lack of prescribers, owing both to staffing shortages and prescriber hesitancy; inequitable access, particularly in rural and remote communities; and medications that often don’t meet the needs of the people the programs are intended to serve.
The report also underscored the importance of regular public reporting for such a novel program. The audit found that while the ministries periodically reported limited information, it has yet to deliver on a public dashboard with more detailed information that was promised for September, 2022.
Despite public concerns about medications from the program falling into the hands of people for whom they were not prescribed, the Ministry of Mental Health and Addictions has not publicly reported on work to develop an “enhanced monitoring plan” on diversion, the report said.
The ministry did not answer questions from The Globe and Mail about the dashboard but said in a statement that data from the program would be added to a “data snapshot” on mental health and addictions care in coming weeks. The ministry works with policing partners to monitor diversion, and scientists with the Centre for Advancing Health Outcomes at UBC are piloting a chart review process to monitor new cases of opioid-use disorder, including from diversion, the statement said.
On overdose prevention and supervised consumption services, the audit found that while they had high-level operational guidance, it didn’t include standards to ensure quality of care, availability or accessibility. It also noted that while the ministries consulted with health authorities, people who use drugs and Indigenous people, their feedback wasn’t always reflected in the guidance. The audit found the guidance to be out of date, citing as examples that most illicit drug deaths are now caused by inhalation – not injection – and that the addition of benzodiazepines to the illicit drug supply have made overdoses more complex.
The report described a lack of progress in addressing persistent barriers, such resistance from municipalities that use means such as bylaws to prevent health authorities from opening overdose prevention sites.
Among recommendations, the report called on government to report regularly to the public and health sector partners on whether prescribed safer supply is meeting its objectives. As well, the ministries should develop provincewide service standards for overdose prevention and supervised consumption services, updated guidance and strategies to address long-standing barriers to implementation.
At an unrelated news conference on Tuesday, Premier David Eby acknowledged the report’s findings of barriers to accessing those prevention services, especially in remote parts of B.C.
He said it was important to note that Mr. Pickup was not saying to stop the program.
“He’s not saying the program doesn’t work. He says he wants more of it in every part of the province. This is a challenge for us.”
With a report from The Canadian Press