Bold changes and a dramatic expansion are coming to safe supply efforts in B.C. in response to an increasingly toxic drug supply and the deadly overdose crisis.
Eligibility for safe supply — prescribed untainted drugs or alternatives — will expand to nearly all people who access the street drug supply, even intermittently, under a policy directive from the B.C. Centre on Substance Use being finalized with the province.
And registered nurses and registered psychiatric nurses will soon be able to prescribe controlled substances under a public health order from provincial health officer Dr. Bonnie Henry.
Previously, only doctors and some pharmacists were allowed to prescribe safer alternatives to illicit drugs.
“We know the pandemic has only made the street drug supply in B.C. more toxic than ever, putting people who use drugs at extremely high risk for overdose,” said Henry in a news release. “Giving physicians and nurse practitioners the ability to prescribe safer pharmaceutical alternatives has been critical to saving lives and linking more people to treatment and other health and social services.”
Several new substances will also be covered under provincial Pharmacare at no cost to users and multiple methods of administration will be supported, including injection, inhalation and smoking. The full list of substances included in the directive has not been finalized.
Guy Felicella, peer advisor at the B.C. Centre on Substance Use and Overdose Emergency Response Centre, says this is a landmark change for people who use drugs and their loved ones.
“This is our generation’s Insite,” he said in an interview, referring to North America’s first supervised injection site that opened in Vancouver in 2003. “It’s a credit to people’s resilience to keep pushing, it’s life-saving and life-changing.”
B.C.’s existing safe supply guidance was expanded in March to respond directly to pandemic-driven overdose risks, such as increased social isolation and a more toxic drug supply due to the border closure.
But one had to be at risk of both COVID-19 and of overdose in order to be eligible for the expanded access.
Minister of Mental Health and Addictions Judy Darcy said that while the initial response in March helped separate about 1,600 people from the street drug supply, it quickly became clear that more needed to be done.
“Clearly the risk of overdose is enormous, and if people are accessing the illicit drug supply, then they are at risk of dying, and we needed to do something more," she said in an interview.
The new directive only requires that someone be at risk of overdose, and Darcy said everyone who is eligible will still undergo a thorough medical screening by a health-care professional.*
Nurses and physicians will undergo training around the guidelines and work with community members to link them to suitable primary and continuing care. Safe supply substances will also be able to be dispensed in community and health authority pharmacies, increasing access points for people across the province.
“This will alleviate the pressure of the toxic drug supply,” said Felicella, and “allow people to focus on other things, like getting housing or connecting with family.”
When people’s days aren’t consumed by the effort to find and pay for drugs, they can work at tasks like finding stable housing and are less likely to engage in crime or survival sex work, according to studies on people who use prescribed medical-grade heroin or alternatives at the Downtown Eastside’s Crosstown Clinic.
“If people have access to a pharmaceutical or opioid, then they don’t need to turn to the street and the illicit market,” said Dr. Scott MacDonald, medical lead at the Crosstown Clinic, in an interview. “Safe supply is safe, it’s clinically effective, it’s cost effective... and it reduces property crime and violent crime.
“I really don’t understand the delay in expanding access.”
Giving nurses prescribing powers will also be a massive step for rural, remote and Indigenous communities without regular or easy access to family doctors.
Sherri Kensall, interim chair of Nurses and Nurse Practitioners of BC, welcomed the change.
“Nurses stand ready at all levels to interact with people who use substances and will utilize supportive harm reduction, coupled with increased prescriptive authority as well as expanded access to referral for ongoing treatment and support to save countless lives,” said Kensall.
Nurses embedded in other social service organizations can also connect community members to prescription options without having to refer them outside a familiar environment.
And if substances are available at a nearby pharmacy, nurses could even accompany community members in person to collect their prescription and administer it.
MacDonald said that’s important. “We don’t need a bigger Crosstown. We need to meet people where they’re at.”
Felicella said the “bumpy roll-out” of new safe supply guidance this spring is a lesson in the importance of training doctors and nurses in new practices.
The full list of included substances is yet to be confirmed, but Felicella is optimistic the changes will take effect quickly.
Felicella said the announcement is a giant step forward — “tears rolled down my face when I heard.”
But it shouldn’t make the public or government lose sight of what is still to be done, he said.
Safe supply does not solve the origins of trauma and pain that cause people to start using illicit drugs, but it works with harm reduction to offer “a pathway to hope,” said Felicella, a former substance user. Work on those sources of trauma and strengthening other supports must continue, he said.
But today’s announcement is a cause for celebration, he said.
“I’ve lost a lot of friends who could have benefited from this. I’m celebrating with them.”
*Story updated at 3:08 p.m. on Sept. 16 to include comments from Mental Health and Addictions Minister Judy Darcy.
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