B.C. should expand safer-supply program despite risk of drugs reaching users without prescriptions, top doctor says

A new report from Dr. Bonnie Henry has called on the B.C. government to broaden the availability and types of drugs that can be prescribed under the province’s controversial safer-supply program.

But the provincial health officer also acknowledged Thursday that the pioneering program carries some societal risks, and urged B.C. to create a scientific and clinical committee to address concerns and evidence arising from it.

B.C. is the first province to have a safer-supply program, which allows medical prescribers to give substance users regulated versions of some opioids.

“This policy, in its intent, is an important part of the spectrum of medical care we are providing — and need to continue to provide — for people who use drugs in the province,” Henry told media Thursday on the release of her report, titled A Review of Prescribed Safer Supply Programs Across British Columbia.

“The program does not go far enough in terms of the medical model to meet those needs … The medical model must be expanded.”

WATCH | Chief coroner worries about safety of drug users:

As she heads into retirement, B.C.’s chief coroner Lisa Lapointe says she worries that the political winds have turned against drug decriminalization, and that people who oppose it don’t understand how safe supply saves lives.

Henry said she was asked by the province last spring to scrutinize any risks and benefits of the initiative and to issue recommendations.

Her report comes amid growing controversy around prescribed safer supply, which B.C. launched in March 2020.

Last year, a record 2,511 British Columbians died as a result of unregulated drugs, the equivalent of nearly seven deaths a day. That represents a five per cent increase compared with the previous high of 2,383 deaths recorded in 2022. 

B.C.’s mental health and addictions minister said the provincial government will continue to offer a broad range of support for substance users — including treatment and recovery, harm reduction, housing and employment programs — not just prescribed safer supply.

“This program is one part of a comprehensive approach to saving lives,” Jennifer Whiteside told reporters following Henry’s news conference. “We are going to continue to work all across that continuum … to keep people alive and connect them to the care they need.

“Our focus now is to look at improving the current model that we have.”

Whiteside called prescribed safer supply an important step to helping people accessing opioid replacement therapy, as well as treatment services.

Asked about concerns over the scarcity of definitive scientific evidence for safer supply, she said Henry’s proposal for a scientific and clinical committee is “under consideration” by the province.

Drug diversion fears

Critics have expressed concerns that some of the regulated drugs may be making their way to unintended substance users without a prescription, known as diversion.

“Emerging evidence indicates diversion of prescribed substance(s) is occurring and may be causing harms,” Henry’s report states.

However, she said there is no evidence that more youth are being diagnosed with opioid use disorder since the province launched its prescribed supply program — in fact, she found the opposite.

But she acknowledged that issues surrounding “diversion and diversion mitigation result in moral distress for some prescribers.”

“We need to understand that better,” Henry said on Thursday. “Clearly, for the unmet needs, we need expanded access to medications that do meet people’s needs, so you don’t need to sell the drugs you have.”

She added that B.C. must ensure officials have a “better understanding of whether or how” youth are accessing prescribed opioids.

Chris Dunham, who receives methadone treatment, told CBC News he often sold his previous prescription of hydromorphone (also known as Dilaudid) and diazepam (also known as Valium) on the streets because he found them ineffective.

“To get other drugs [to] get high on, like fentanyl … I sold them all the time,” the 54-year-old said. “I think the heroin program is probably good but … don’t take it home so it can’t be diverted.

“All these dilaudids are going to the streets and addicting other people … I don’t want other people to have to go live the life I’ve lived.”

‘It saved my life’

On the other side, substance users and some health providers have said it is too difficult to access the prescriptions for users at greatest risk of dying from toxic, illicit drugs. 

Henry therefore called on the province to expand its prescription program to include more commonly used forms of drugs including diacetylmorphine — or pharmaceutical heroin — and powdered fentanyl.

For one patient who receives prescribed heroin in Vancouver’s Downtown Eastside, the program has been a life-saver as she watched many of her peers die of overdoses (ODs).

“Everyone was OD-ing and dying,” Claudia West said. “I haven’t touched street drugs since I joined the program … It’s been helping me keep clean from street drugs for over two years now.

“It saved my life, because I was doing fentanyl.”

WATCH | One patient in B.C.’s prescribed safer supply program says it saved her life: 

Former illicit fentanyl user Claudia West believes B.C.’s safer supply program has kept her alive as she watched many of her peers die of overdoses. She now receives medically prescribed heroin in Vancouver’s Downtown Eastside.

‘Research is largely positive’

Currently most of the prescribed supply under the program has been hydromorphone in tablet form, said Dr. Alexis Crabtree, the B.C. Centre for Disease Control’s medical lead of harm reduction and substance use services.

“Hydromorphone tablets are not a substance that is working for everyone,” she told reporters on Thursday.

Additionally, she said, there’s not yet strong enough research to definitively say prescribed safer supply is an effective “evidence-based intervention.”

But what little data there is suggests the program is worthwhile, if it can be expanded to more substances, she argued.

“The research is largely positive regarding prescribed safer supply,” said Crabtree, who is also a clinical instructor at UBC’s School of Population and Public Health.

On Jan. 24, Chief Coroner Lisa Lapointe renewed her plea for an expansion of safer supply and a “systems change” that treats substance use as a health issue, not a criminal problem.

Following Lapointe’s remarks, B.C. United leader Kevin Falcon said on social media that the grim death toll was an indictment of the B.C. NDP’s policies, including the “reckless decriminalization” of small amounts of certain illicit drugs.  

According to the province, 4,265 people were prescribed an opioid alternative under the $184-million program in November 2023.