British Columbia should expand safer supply program despite drug diversion risks, provincial health official says

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A new report from Dr. Bonnie Henry calls on the British Columbia government to expand the availability and types of medications that can be prescribed under the province’s controversial Safer Supply program.

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

British Columbia is the first province to have a safer procurement programwhich allows medical prescribers to give substance users controlled versions of certain opioids.

“This policy, in its intent, is an important part of the range of medical care that we provide – and must continue to provide – to people who use drugs in the province,” Henry told media on Thursday. of the publication of its report. title A review of safer procurement programs mandated in British Columbia.

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

WATCH | The chief coroner is concerned about the safety of drug addicts:

Safety procurement backlash ‘terrifies’ B.C.’s chief coroner

As she nears retirement, British Columbia’s chief coroner, Lisa Lapointe, says she worries that the political tide has turned against drug decriminalization and that people who oppose it do not understand how a secure supply saves lives.

Henry said the province asked him last spring to review the risks and benefits of the initiative and make recommendations.

Its report comes amid growing controversy around a prescribed safer supply, launched by British Columbia in March 2020.

B.C.’s Minister of Mental Health and Addiction says the provincial government will continue to offer a wide range of supports to people with addictions – including treatment and recovery programs, harm reduction, housing and of employment – ​​and would not simply prescribe a more secure supply.

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

“Our focus now is on improving the current model we have.”

Whiteside called the prescribed safer supply an important step in helping people access opioid replacement therapy, as well as treatment services.

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

Patients receive intravenous doses of the painkiller hydromorphone, or Dilaudid, up to seven times a day as a replacement for illicit drugs.
Patients receive intravenous doses of the painkiller hydromorphone, or Dilaudid, up to seven times a day as a replacement for illicit drugs. (Ashley Burke/CBC News)

Fears related to drug diversion

Critics have raised concerns that some of the regulated drugs could be funneled without a prescription to unwitting substance users, known as diversion.

“Emerging evidence indicates that diversion of prescribed substances is occurring and could cause harm,” Henry’s report said.

However, she said there is no evidence that more young people are being diagnosed with opioid use disorder since the province launched its prescription supply program – in fact, she has found the opposite.

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

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

“We need to ensure we better understand if and how children and youth access opioids.

On the other hand, addicts and some health care providers have said it is too difficult to access prescriptions for users most at risk of dying from toxic and 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.

“The research is largely positive”

Currently, most of the program’s prescribed supply is hydromorphone in tablet form, said Dr. Alexis Crabtree, medical lead for harm reduction and addiction services at the BC Center for Disease Control.

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

Additionally, she said, there is not yet strong enough research to say with certainty that a prescribed safer supply is an “effective, evidence-based intervention.”

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

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

Last year, a record 2,511 British Columbians have died due to unregulated drugs, the equivalent of nearly seven deaths per day. This represents a 5% increase from the previous record of 2,383 deaths recorded in 2022.

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

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

According to province4,265 people were prescribed an alternative to opioids under the $184 million program in November 2023.

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