A fentanyl user displays a 'safe supply' of opioid alternatives, provided by the local health unit to combat overdoses due to poisonous additives, in the Downtown Eastside of Vancouver on April 6, 2020.JESSE WINTER/Reuters
B.C.’s program to prescribe some drug users with a safer supply is being reviewed, the Provincial Health Officer says, as officials examine whether it should cover more people and make more pharmaceutical alternatives available.
Dr. Bonnie Henry told a news conference Monday that the province will review the guidelines for the safer-supply program, which was introduced in 2020, based on the best available evidence and feedback from clinicians and people who use drugs. She said the current model, which requires the drugs to be distributed in a clinical setting, may discourage users from participating, and that the review will look at alternative methods that reduce that barrier.
“What we’re doing with legalization and regulation of cannabis fits into that, where you have enough controls and you have enough regulation, but you also have monitoring and safety of the product,” Dr. Henry said. “So in the long term, would that be a way to counter the toxic street drugs and take that business away from organized crime? Absolutely. But we’re not there yet.”
She said a revamped safer-supply program should work in tandem with ensuring better access to treatment and housing, and enforcement of drug laws on those who traffic in deadly substances.
Dr. Henry was joined at the news conference by Lisa Lapointe, B.C.’s chief coroner; Jennifer Charlesworth, B.C.’s independent representative for children and youth; and Dr. Kelsey Louie, deputy chief medical officer for the First Nations Health Authority. They decried the portrayal of Vancouver’s Downtown Eastside as the epicentre of an out-of-control drug crisis and other misinformation that they said has politicized the debate on safer supply.
Federal Conservative Leader Pierre Poilievre and BC United MLA Elenore Sturko, the opposition critic for mental health and addiction, have pushed back against safer supply. Last month, the federal Conservatives proposed a motion denouncing the government’s handling of the drug crisis. In introducing the motion, which was defeated, Mr. Poilievre referred to supporters of safer supply as “members of the ‘misery industry,’ those paid activists and public-health bureaucrats whose jobs depend on the crisis continuing.”
Safer supply is predicated on the idea that, by providing people at high risk of overdose from illicit drugs with pharmaceutical alternatives, health care providers can reduce that likelihood as well as other related harms.
Dr. Henry said she wants the review of safer supply to examine whether it should include greater access to opioid alternatives other than hydromorphone – the medication currently most commonly used in such programs. She said clinicians have concerns that hydromorphone is not meeting the needs of drug users who have been exposed to a much more toxic and contaminated supply.
“We know that there are a variety of different opioids that would be of benefit for people, and we have some limited data of people using powdered fentanyl to support people getting off the toxic street drugs that they would have otherwise accessed that has been promising,” she said.
Also under review is whether people who use drugs must go through the medical system to gain access to a safer supply. That can be a barrier for some people, Dr. Henry said.
“Are there non-medical models that still have controls? So it’s not just drugs being available to people whatever they want, whenever they want, but what we need to have is controls that meet people’s needs with different medications being available and different types of models.”
Dr. Paxton Bach, an addiction-medicine specialist at St. Paul’s Hospital in Vancouver and co-medical director at the British Columbia Centre on Substance Use, agreed the province’s safer-supply program needs to be expanded.
He said prescribed safer supply has been a tool for clinicians to help support people who are at risk of dying from the toxic drug supply, but the scale of people at risk of harm and the speed at which that supply is evolving make it impossible for a medical approach alone to address.
Dr. Bach said he agrees with Dr. Henry’s comments that multiple models for accessing a regulated and predictable drug supply are needed, and that appropriate models will vary widely depending on the population, the context and the drug itself.
For example, he said community-led approaches such as compassion clubs and co-ops are one example of a possible approach, but any model must be tailored carefully to the local environment and the specific needs.
Dr. Bach added that any legally regulated system should balance benefits and harms to ensure that those who access it can consume with relative safety while minimizing potential individual and social harms.
“Our current approach leaves the production and distribution in the hands of organized crime, and they have no such considerations when their only motive is profit,” he said.
Dr. Henry acknowledged that clinicians have reported that some people are getting safer-supply drugs to feed their own habit, which is “concerning.” But she said it makes up only a “very, very tiny percentage of what is out there.”
Ms. Lapointe, the province’s chief coroner, took exception to suggestions that hydromorphone tablets have been widely diverted to the streets.
Instead, she said hydromorphone is not present in “any significant numbers” as a cause of death for people who have died of an overdose.
“Facts must take precedence over partisanship,” she said, without naming any politician.
Dr. Henry said the safer-supply program review has already started, and will continue over weeks and months. She said she could not offer a date for when conclusions will be drawn, calling it an “iterative” process.
“However long it takes us,” she said.