Seventeen months after the B.C. government committed to expanding safe supply, only about 500 people are able to access real replacements for increasingly poisoned drugs.
In February, Minister of Mental Health and Addictions Sheila Malcolmson said 12,000 people had been prescribed what she has called both “safe supply” and “safer supply.”
“Since we first introduced prescribed safe supply in March 2020, there have been more than 12,000 people helped with this groundbreaking response,” Malcolmson said.
But public health experts and advocates say the B.C. government is misrepresenting its safe supply programs as toxic drug deaths soar, with seven people a day dying in November and December.
The government’s claim that 12,000 people have accessed safe supply is actually a count of people who have received prescriptions for withdrawal management substances and alternatives like hydromorphone.
But only about 500 British Columbians have access to true safe supply through a handful of mostly federally funded pilot projects in the Lower Mainland and Victoria.
It is conservatively estimated 83,000 people have opioid-use disorder in B.C. That doesn’t include people whose opioid use wouldn’t be considered an addiction or who use other substances like methamphetamine, cocaine or benzodiazepines — substances that are also linked to deaths from toxic drugs.
Critics say the government is misleading the public and substance users about its commitment to saving lives.
“The government is saying they’re doing safe supply but in reality, they’re relying on the old-school approach of ‘we want to stop people from doing drugs,’” said Dr. Mark Tyndall, a professor at the University of British Columbia and former executive director of the BC Centre for Disease Control. “But right now, people really need an alternative supply of drugs.”
Safe supply is a method of harm reduction aimed at providing regulated substances for people instead of the poisoned and unpredictable criminalized supply, which killed 2,224 people in B.C. last year.
It provides low-barrier access for regular, intermittent and casual users to predictable, non-poisoned street drugs like fentanyl, cocaine, heroin and methamphetamines.
A December death review panel convened by the BC Coroners Service found a majority of people dying of toxic drugs were not frequent users and did not have diagnosed substance use disorders.
But information provided by the ministry and data from the BC Centre for Disease Control show the government’s claim of extending safe supply to 12,207 people is a count of those prescribed pharmaceutical alternatives to manage withdrawal from street drugs.
Many of these prescriptions happened under early pandemic prescribing guidance that encouraged doctors to connect people at high-risk of COVID-19 and overdose with alternatives to minimize drug-seeking that may transmit the virus. They generally provided short-term prescriptions under three weeks, according to BCCDC data.
Tyndall said that’s not safe supply and doesn’t allow people to avoid using toxic illicit substances long-term.
About 58 per cent of the 12,207 people received prescription opioids like oxycodone or hydromorphone, 17 per cent received stimulants like Ritalin, 13 per cent received benzodiazepines and the remaining 24 per cent received alcohol withdrawal medications.
The substitutes aren’t safe supply, Tyndall said, and don’t replace criminalized substances. That’s key to making safe supply a viable solution for people who would otherwise access the toxic street supply.
“For someone using fentanyl, being prescribed hydromorphone is a drop in the bucket,” he said, noting that many of these prescriptions are less than two weeks long.
“It’s not real safe supply at all.”
Hydromorphone, sold as Dilaudid, is a moderate to strong opioid prescribed for pain management. It is less potent than heroin, and far less strong than fentanyl or carfentanil.
Tyndall said using an alternative like hydromorphone often reduces use of the illicit supply and therefore lowers the risk of drug poisoning.
But under current prescribing rules patients are cut off if they are also using street substances, and many doctors won’t even prescribe alternatives to those also using illicit drugs.
That means many people are denied access to prescription alternatives.
When asked to respond to criticism that the province is misrepresenting the availability of safe supply, Malcolmson did not respond directly.
"I have heard from prescribers, care providers and people with lived experience, and I agree — expanding safer supply is a vital step to reduce deaths from toxic drugs. That’s why we have expanded our program,” she said in a statement to The Tyee.
What B.C. is calling prescribed safer supply evolved from Risk Mitigation Guidance issued by the province and the BC Centre on Substance Use in March 2020 so doctors could prescribe withdrawal management medications for people at heightened risk of toxic drug poisoning who needed to isolate due to COVID-19.
The directive was expanded in mid-2021 after a promised expansion of safe supply in September 2020, and now includes fentanyl patches.
“These guidelines are not intended for treatment of substance use disorders but rather to support individuals with substance use disorders to self-isolate or social distance and avoid risk to themselves or others,” the guidance noted.
They require people to have a substance use disorder to receive a prescription. The vast majority of those covered — 94 per cent — must access a single day’s medication every day and use it at the pharmacy.
That’s a barrier that makes it impossible for many people to participate.
Garth Mullins, an advocate who helped develop the initial Risk Mitigation Guidance, said the goal was to move quickly on any actions that would reduce toxic drug deaths occurring during the pandemic, rather than making transformative change in the province’s response to the toxic drug crisis.
Tyndall said pressure from the College of Physicians and Surgeons means most doctors are trying to taper people off the risk management prescriptions and, for opioid users, onto long-term treatments like Suboxone and methadone as soon as they can.
BCCDC data suggests the prescriptions were intended as a step toward treatment rather than to provide access to a non-poisoned drug supply.
The government continues to rely on abstinence-focused approaches, Tyndall added.
Mullins, a board member for the BC Association of People on Methadone, said B.C. lags behind other jurisdictions around the world in providing access to opioid agonist therapy, which aims to replace illicit opioids with prescribed substitutes that manage withdrawal symptoms but don’t replicate the effects of the drugs.
City of Vancouver drug policy advisor Karen Ward said the government’s claims about “safe supply” misrepresent the nature of the toxic drug crisis.
“We have to take a public health approach,” she said in a message to The Tyee. “Arguments about how many prescriptions are active misses the point: they are not addressing the supply.”
Switching to a safe supply model could include the use of compassion clubs, like those that led in providing medical cannabis. Vancouver city council has supported the Drug User Liberation Front’s application for federal permission to start a compassion club for heroin and other substances in Vancouver.
Tyndall and Mullins agreed the focus on programs that require prescriptions ignores the limits of a medical model of safe supply. The barriers to meeting the requirements for a prescription mean few people at risk can access non-poisoned drugs.
“As long as it's a medical model where you need a prescription, it'll never be able to be scaled up to the point where it makes a difference in people's overdoses,” said Tyndall.
All three are also concerned that mislabelling the current program as safe supply will confuse the public and allow leaders in B.C. and elsewhere to dismiss the potential of safe supply before it is even really attempted.
“When the deaths continue to rise, they’ll say, ‘We tried nothing and we’re all out of ideas,’” Mullins added. “But compared to the scale of the problem, we really haven’t tried to implement the solutions.”
For drug users who thought they would soon have a safe supply option, the government’s claims feel like a betrayal.
“We haven’t changed the options for people… who continue to use and risk their lives every time,” said Tyndall.
“We need to pull back on the prohibition and offer people a safe supply of drugs.”