'Unintended consequence': What B.C.'s review of safer supply says about drug diversion

Diversion of prescribed opioids is not a reason to halt or scale back B.C.'s safer supply program, health officials said Thursday while sharing a review of the harm reduction initiative.

The program's attempt to mitigate "certain and severe harm" for those most at risk of dying outweighs the potential risk of "some harm" for the broader population, according to Dr. Bonnie Henry's A Review of Prescribed Safer Supply Programs Across British Columbia: Recommendations for Future Action.

Henry noted the review was launched – in large part – due to "concerns and challenges" regarding this unintended consequence of the province's response to a toxic drug crisis that continues to kill British Columbians in record numbers.

"The goal of this review was to better understand these concerns, to understand how the prescribed safer supply program was actually being used in the province, and to make recommendations to government about the continuation – or not – of the program," Henry said at a news conference detailing the findings of the review.

The claim that hydromorphone being prescribed through the province's limited safe supply programs is flooding the streets and causing an increase in harm, addiction and death, particularly among youth, was one of the concerns the review sought to address.

The goal of the prescribed safer supply program – what Dr. Alexis Crabtree with the B.C. Centre for Disease Control described Thursday as its "intended consequence" – is to "reduce deaths from drug poisoning."

Diversion, Henry said, does happen, but the extent and impact is unknown. For people who use drugs, diverted opioids can be an alternative to the poisoned street supply. Diversion to people who don’t already use drugs and start to, on the other hand, can be harmful, she explained.

"Diversion is not, in itself, good or bad or right or wrong," Henry said. "There are things that it tells us."

One thing that diversion signals, the review said, is "unmet needs among people who use drugs." This could mean that the people accessing the program, for example, are not being prescribed drugs that are "adequate substitutes" for what is available on the illicit market. Another unmet need, as Henry alluded to, is that people who can’t access the program are looking for alternatives to the illicit supply.

Concerns about diversion, therefore, may be best addressed by making sure the program works better for people and is more widely available, according to the review – which recommends expanding the program to not only provide more people with access, but also to include substances like fentanyl and heroin.

Still, the issue of potential diversion to youth in particular is one the review says deserves attention. The available evidence shows that there has not been an increase in diagnoses of opioid use disorder among youth since the safer supply program launched, nor does it show that diverted drugs have contributed to the ever-increasing number of deaths in the province.

But those two things, while "reassuring," don’t negate the need for a more in-depth look.

"A greater emphasis should be placed on monitoring for unintended consequences. Monitoring should include primary data collection with youth about their use of substances generally and their access to diverted medications specifically," the review says.

"There is a need to understand how youth initiate and obtain opioids," it also reads.

However, Henry also acknowledged that isolating the impact of the safer supply program on youth when it comes to drug use is not an easy endeavour.

"It's very difficult to separate this specific issue from the context that we're in," she said.

"We know that in these last four years we've seen an increase in mental health issues in children. And the impact of those on some children and youth has been an increase in accessing or trying to use substances to help deal with these issues."

The review contains a host of recommendations aimed at improving the program and the province's overall response to the toxic drug crisis.

Mental Health and Addictions Minister Jennifer Whiteside says the government will be reviewing those recommendations to "determine next steps."

Last year, 2,511 people died from toxic drugs in the province – the highest number ever recorded.

Twenty-seven people under the age of 18 died from toxic drugs in 2023, a decrease from 36 deaths in 2022 and 31 in 2021, according to data from the BC Coroners Service.