When Politicians Play Doctor, People Die

We are British Columbian health-care providers who are experts in the care of people with addictions.

Back in February, B.C. Health Minister Josie Osborne announced significant new restrictions to the “prescribed alternatives policy.” That policy encouraged us to prescribe certain medications that are an essential life-saving tool we employ to keep our patients alive in the face of the worst mass poisoning crisis in history.

This announcement followed allegations made in what appears to be an internal law enforcement document that large quantities of medications prescribed under the program were ending up in the hands of organized crime.

However, as former chief coroner Lisa Lapointe has said, the government has yet to produce any evidence that this was in fact occurring at a scale that we ought to be concerned about.

Nor do the document, the government and law enforcement agencies seem willing to make the distinction between counterfeit pills that look like those prescribed as safer supply and medications actually repurposed in significant numbers from safer supply programs.

Counterfeit tablets are a real public health concern. Last month, for instance, an Interior Health “drug alert” for Nelson warned of “counterfeit Dilaudid tablets containing a fentanyl analogue.”

As experts in this field, we know that someone expecting to receive a pharmaceutical-grade hydromorphone (brand name Dilaudid) tablet who instead receives a close relative of fentanyl is at high risk of overdose. Indeed, much more so than if they could access what they are truly seeking: a predictable alternative that really is what it says on the label.

For some time, we have benefited from peer-reviewed research that shows that medication prescribed under the program both directly saves lives and boosts the likelihood that patients stick with traditional addiction treatment medications like methadone, which themselves save lives.

Just last month, a new paper published in The Lancet that evaluated similar programs in Ontario found that prescribed alternatives reduced overdoses, emergency department visits, hospitalizations, infections and health-care costs among those receiving the medication.

As nonsensical as the government’s policy announcement was, we believed that “cooler heads would prevail” and that when it came time to develop the actual medical guidelines that would inform a shift in practice in our field, the government would consult widely with experts in this field and with those who are always most affected by the whims of government policy — the patients and families struck by this nine-year-long public health emergency.

This was not to be.

Without consultation, the BC Centre on Substance Use, the provincial organization that produces clinical guidance on the practice of addiction medicine, released an “Interim Clinical Resource” purporting to guide us in ethically implementing the province’s policy direction.

The document is a stark example of medical decision-making guided by political whim and not science. The problems with it are too numerous to list here, but in essence it needlessly restricts the clinical judgment of experts, hamstringing us from practising medicine in the way we were all trained: with the patient at the centre.

It doubles down on a punitive approach to urine drug testing, something we know is ineffective and harmful.

And it openly acknowledges that this shift will cause disproportionate harm to Indigenous people, “including higher rates of fatal and non-fatal opioid drug poisonings,” while offering flowery language but nothing of substance to address this new round of systemic racism.

We now suffer the moral distress of being medical experts in this field who are essentially forced to be handmaidens to a government policy that will cause more death. And not just death in the abstract — death of people we personally know and have cared for for years.

When the definitive history of this crisis is written, this “Interim Clinical Resource” will stand out as a particularly egregious example of government hypocrisy and self-deception.

What’s more, we fear for what this means for the practice of medicine more broadly. This blatant political interference is likely to spread to other areas of health care.

We wonder if the health minister, who has spoken passionately about the need for access to reproductive care, has considered that she has cracked the door open wider to political interference in the provision of abortion?

We wonder if the premier, who has spoken eloquently about the rights of transgender youth, has considered that he is making it easier for his opponents to meddle in the provision of gender-affirming care, as has happened in Alberta?

It may seem politically expedient to “play doctor” and overrule science and expertise in our important area of practice, but how long before we see the walls come crashing down as fear and pseudo-science trump expertise more broadly? Calls to politically interfere in the practice of medicine should be vociferously resisted, not catered to. Our government has taken a genie out of the bottle that will be very difficult to put back in, to the detriment of the health of all British Columbians.

As always, we welcome any opportunity to collaborate with policymakers to offer evidence-based solutions to the toxic drug poisoning emergency. We know too well what happens to our patients when we’re ignored.

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This article was written by Dr. Evan Ailon, Dr. Patricia Caddy, nurse practitioner Justina Doerksen, Dr. Jacquie Erickson, Dr. Jessie Flear, Dr. Ryan Herriot, nurse practitioner Kate Hodgson, Dr. Marc Likharovich-Fournier, Dr. Erika Kellerhals, nurse practitioner Bryce Koch, Dr. Elizabeth Plant, Dr. Kelsey Roden, Dr. Jess Wilder and Dr. Jill Wiwcharuk.