Safe supply in B.C.: Top doctor recommends expansion of prescription program

B.C.'s top doctor is pushing for an expansion of the province's safer supply policy, saying in a report the program is "an ethically defensible way" to reduce harms for people who use drugs.

Dr. Bonnie Henry released a 96-page report Thursday, reviewing the province's prescribed safer supply program. The aim of the report is to not only improve the lives of those who use drugs in the province, but to support the work of clinicians.

"There are very important stories and voices (in the report) and they are varied," Henry said during a news conference Thursday, explaining that clinicians, people with lived experience and colleagues were consulted. "Many things that we heard from many different groups of people and there was not one unified voice around this program."

B.C.'s prescribed safer supply policy was first introduced in 2021 with the province committing $22.6 million in direct funding to health authorities to lay out the foundation of the program over three years. At the time, the province said the funding would also go towards supporting the planning, phased implementation, monitoring and evaluation of prescribed safer supply services.

Some of the recommendations in Henry's review include expanding the substances that can be prescribed to drug users. The report explained hydromorphone tablets are currently the most accessible and widely prescribed substance. However, clinicians consulted for the report shared the tablets had limited benefits for those with higher opioid tolerance. The report proposed expanding access to fentanyl powder and diacetylmorphine, or heroin, through the program.

The report also noted the challenges some populations have in getting a prescribed safer supply, including a lack of access to clinicians. For others, the report noted, the medical system may not feel like a safe space for people who use drugs.

Diversion an 'unintended consequence'

With the release of the report, health officials acknowledged concerns substances being accessed through the safe-supply program could be diverted to others. However, the report indicated the extent of that diversion is unknown, adding some may be going to people otherwise at-risk of drug poisoning.

"The unintended consequence most people are concerned about is diversion of the medications," Dr. Alexis Crabtree with the B.C. Centre for Disease Control said during Thursday's news conference. "We know from qualitative research about patients who have accessed prescribed safer supply that some of them do share or sell their medications, particularly when they feel those medications don't act as an adequate substitute to unregulated drug supply."

Crabtree said there are "a variety of reasons" for this, including "supporting others who might not have access to safer supply."

Crabtree also said the provincial coroner, as it investigates all drug-poisoning deaths in B.C., has "consistently" reported hydromorphone and other prescribed safer supply substances are not "a direct contributor to rising deaths from drug poisoning."

Specifically speaking about youth, Crabtree called it a "significant concern" that youth could potentially access diverted opioids, but said there is extremely limited data on the matter. She did, however, point to data up to the end of 2022 that showed diagnoses of opioid use disorders among youth had not increased in the province. 

The province declared a public-health emergency over drug-related deaths in 2016. Since then, deaths due to drug toxicity have continued to escalate, with 2023 seeing the highest number yet.  Henry's report said the COVID-19 pandemic only exacerbated the crisis, as shutdowns created barriers to accessing medical and harm-reduction services. As well, the global drug trade was disrupted, leading to a change in toxicity of drugs, the report explained.

Non-prescription model

While Henry's report focused on enhancing prescribed alternatives, the province's chief coroner, Lisa Lapointe, has called for a model that doesn't require a prescription. 

Premier David Eby, however, said he disagreed with Lapointe's call. 

"I do not believe that the distribution of incredibly toxic opioid drugs without the supervision of a medical professional in British Columbia is the way forward and the way out of the toxic drug crisis," Eby said in a news conference last week.

Eby said he believed the only way out of the crisis was to prevent people from using toxic street drugs and help them rebuild their lives, such as opening more detox spaces.

"Our vision is that no person should have to wait for detox," Eby said. "No person should have to wait for treatment."

Mental Health and Addictions Minister Jennifer Whiteside, spoke to reporters after the report was released.

"The program is an important tool to help people at risk of toxic drug poisoning. We are reviewing the recommendations with our partners to determine next steps," she said.

One of the recommendations in the report was "to develop policy options for implementation of additional medical models not based on individual prescribers and non-medical models of access to regulated alternatives to the toxic drug supply."

Asked about that specifically, Whiteside said, "our focus right now is on improving the current model that we have."

One recommendation Whiteside did say the province will accept and implement immediately is to rename the program, referring to it as "prescribed alternatives" instead of "prescribed safer supply." 

With files from The Canadian Press