B.C. needs non-prescription safe drug supply to curb OD deaths, expert panel says

An expert panel has urged the B.C. government to "immediately" pursue a non-prescription safe drug supply program, arguing the current prescription model is too restrictive to meaningfully combat the province's ongoing overdose crisis.

B.C.'s chief coroner Lisa Lapointe convened the panel – made up of more than a dozen doctors, the chief of the Abbotsford Police Department, and several others with expertise in public health and safety – last December, tasking members with finding the fastest and most effective way to slow the ever-growing death toll from toxic drugs.

Panel chair Michael Egilson said the group's report, released Wednesday, was compiled and submitted in memory of the more than 13,000 lives lost to the crisis since B.C. declared a public health emergency over substance-related harms in April 2016.

"I have trouble simply visualizing how many people that is," Egilson said at a news conference.

"It's more people than the population of Prince Rupert. It's the equivalent number of full-time undergraduate students at Simon Fraser University. If you filled Save-On-Foods Memorial Arena in Victoria – the third-largest arena in British Columbia – there would be another 6,000 people waiting outside."

The panel is the third assembled since 2017 to review B.C. overdose deaths and make recommendations to the government to combat the crisis, each chaired by Egilson, who expressed his personal concern that the staggering number of monthly overdose deaths is becoming an accepted status quo.

"With the passing of each day, week, month and year, we risk becoming numb to the scale of this emergency as the current devastation becomes the norm," he said. "The urgency needed to reduce and prevent further deaths is as great, or greater than it's ever been."

225,000 DRUG USERS AT RISK, PANEL SAYS

The panel's chief recommendation is for B.C. officials to petition the federal government for an exemption to Canada's Controlled Drugs and Substance Act that would allow opioids and stimulants to be made available in the province without a prescription.

Under the current safe supply model, fewer than 5,000 people receive a prescription per month, out of an estimated 225,000 B.C. residents believed to use illicit drugs.

Each of those 225,000 people will continue to be at "immediate risk of significant injury or death" without more government action, said Egilson, who stressed that drug use is not limited to any region, age group, socio-economic class or other demographic.

While Vancouver's Downtown Eastside is the subject of much attention and scrutiny – experiencing a rate of death 10 times the provincial average – the panel pointed out that 85 per cent of overdose deaths occur outside of the neighbourhood.

"Communities from Penticton and Prince George to Kamloops and Kitimat have been forever altered by the loss of family, friends, and neighbours," the report reads, adding that the impacts "will be felt for generations."

Toxic drug overdoses now account for approximately twice as many deaths in B.C. as homicides, suicides, car crashes, drownings and fires combined, and are the leading cause of death among residents between the ages of 10 and 59.

Increasing the accessibility of safe supply is only one component of an extensive suite of evidence-based treatment programs and other initiatives identified by all three death panels as necessary to combat the harms associated with illicit drugs.

"This will take some time to enhance, develop and implement, which is why urgent attention is needed on providing people who use drugs alternatives to the unregulated drug supply," Egilson said. 

ADDRESSING DIVERSION OF SAFE DRUGS

The panel also acknowledged there have been serious concerns in many B.C. communities around the unintended consequences of offering safe supply, including the issue of "diversion" – the re-selling of safe substances for a profit.

Egilson said the members believe better safeguards can prevent those problems while allowing the province to vastly reduce overdose deaths.

"The consensus of the panel is that with a proper system of checks and balances in place, these substances can be provided in a safe and responsible manner," he said.

The experts suggested the government sell non-prescription safe supply at "a price equivalent to unregulated drugs" to remove the incentive for users to re-sell them. The province could still provide safe supply to users unable to afford those prices by allowing them to consume them for free, but only if they remain at designated sites, the panel said.

Speaking at the same news conference, B.C.'s chief coroner highlighted the growing number of Canadian committees, task forces and other organizations that have endorsed safe supply in recent years, including the Canadian Association of Chiefs of Police.

"The notion of safe supply is not radical," Lapointe said. "For the sake of the more than 13,000 families who are grieving the loss of a loved one … and the 225,000 people at risk of dying if vital changes aren't made, I acknowledge the important work of this panel, and urge that courageous action be taken soon."

GOVERNMENT REFUSES RECOMMENDATION

Shortly after receiving the panel's report. B.C.'s minister of mental health and addiction, Jennifer Whiteside, said the province would not be following the experts' top recommendation.

In a letter to Lapointe, the minister wrote that "non-prescription models for the delivery of pharmaceutical alternatives are not under consideration," but suggested the experts' knowledge and experience can still otherwise "help address the stubborn and systemic challenges" the province is facing in relation to substance use.

"We are relying on them to help inform our approach on child and youth mental health and substance use. We require their insights as we work with First Nations, Indigenous, and Métis communities to address the complex and multi-generational needs of Indigenous Peoples," Whiteside said.

"We will continue to seek their advice on these and other urgent issues – and our work to build a comprehensive and integrated system of mental health and substance use care that includes provision of pharmaceutical alternatives through a prescriber model."

Lapointe called the minister's response "disappointing," and suggested the effectiveness of the government's approach can be measured by the lives that continue to be lost, as well as the number of non-fatal overdoses being recorded.

B.C. Emergency Health Services said there were 33,000 paramedic-attended drug poisoning events last year alone, for an average of 92 per day, and Lapointe noted many resulted in severe, long-term health effects for the survivors.

"If we continue to see the number of harms and deaths that we've experienced across the province, I think that identifies a clear gap in the services being provided," she said.

CORONER RESPONDS TO DULF CRACKDOWN

Last week, police raided an unsanctioned compassion club in Vancouver's Downtown Eastside that was selling tested drugs at cost in an effort to reduce the number of overdose deaths in the neighbourhood.

Officers executed search warrants at the Drug User Liberation Front office on East Hastings Street and arrested co-founders Jeremy Kalicum and Eris Nyx, prompting outcry from harm-reduction advocates, including the Canadian Drug Policy Coalition, part of SFU's Health Sciences program.

The enforcement action was supported by B.C. Premier David Eby, however, who said that DULF, despite doing what he described as "life-saving work," was breaking the law and had to be stopped.

Asked about the raid on Wednesday, Lapointe expressed sympathy for those behind DULF's compassion club.

"I think it's hard to appreciate the level of trauma in communities and (among) frontline service providers when they see real people dying in front of them day, after day, after day," she said.

"If you see somebody in a burning house, you feel somewhat justified to smash a window."