A public health expert questions the decision of the provincial government to revise the prescribed alternatives program, colloquially known as safe supply.
"It's very disappointing and it's a real pull-back from some of the things that we need to do to address all these deaths (caused by the toxic drug crisis)," Dr. Mark Tyndall, professor at the UBC School of Population and Public Health and the former executive director of the B.C. Centre for Disease Control, said in an interview with Black Press Media Friday (Feb. 21). "It's disappointing and it's kind of a political retreat of by the (B.C.) NDP government.
Tyndall added that move by government is disappointing because "the only logical or ethical response to people dying from buying poisoned drugs on the street is to offer them an alternative."
Tyndall added that some of the questions in the safe supply debate are reasonable. "But it just means that we need to do a better job of doing it," he said. "It doesn't mean the idea is bad. It means how we fund it and how we do the program needs to be better supported."
Tyndall made these comments after B.C.'s Health Minister Josie Osborne announced changes to the program, acknowledging that diversion of publicly funded pharmaceutical alternatives has taken place. That move came after the leaking of a government document prepared for police participating in a government investigation unit.
"A significant portion of the opioids being freely prescribed by doctors and pharmacists are not being consumed by their intended recipients," it reads without giving any figures illustrating the scope of the problem.
Conservatives including their leader John Rustad, MLA for Nechako-Lakes, and long-time program critic Elenore Sturko, MLA for Surrey-Cloverdale, have spoken of 91裸聊视频渦nknown91裸聊视频� quantities being diverted and Osborne Thursday could also not provide any figures in promising details in the future.
Tyndall also could not give a number, but added diversion was unusual among the group of individuals with whom he worked as part of a program.
"There needs to be some control and regulation of this, but it can be done," he said. "Compared to the number of people, who are actually dying every day and have been dying for a decade of fentanyl, I think diversion...should be a very small concern in the whole scheme of things."
Speaking of his past experience with the program, Tyndall said individuals receiving the prescribed alternative of hydromorphone had to supply urine samples to test whether they were using the alternative.
"So if they came back and they still have fentanyl in their urine, my goal was to get them off buying fentanyl on the street. We would have a discussion, 'OK, so, you are still using fentanyl, what can we do about that? Can we get you some more hydromorphone? How can we make this program work for you?'"
He added that individuals who continued to show fentanyl in their urine but no hydromorphone would not be candidates for the program. "Those people could be identified as those who are likely selling their medication," he said. "So obviously, there needs to be some monitoring going on, but we should not deprive people of a safer supply of drugs just because there is some concern that a few pills are being diverted."
Conservatives have called for a public inquiry into the program amidst unproven allegations of a government cover up, but Tyndall questioned the sincerity of the calls.
"I just find that (call) such political posturing," he said. "They need to have a public inquiry about what has gone so terribly wrong with our response and why so many people have been killed," he said. More than 16,000 British Columbians have died of toxic drugs since the declaration of a public health emergency in 2016. "They are dead," Tyndall said. "So I'm kind of disgusted with the political part of that."
The announced changes marks the second major reversal by the B.C. NDP in its response to the opioid crisis, the first one being changes to decriminalization.
Rustad described the policy shift around safe supply as a 91裸聊视频渕ajor policy victory91裸聊视频� for his party. 91裸聊视频淓by91裸聊视频檚 NDP has caved on one of Eby91裸聊视频檚 signature policy proposals and made a major about-face on their failed radical left-wing safe supply policy,91裸聊视频� he said on social media.
Tyndall also pointed to a third: government's reversal on involuntary treatment.
"There were lots of unintended consequences from that (decriminalization), because we didn't really think through how we would do it and how we would monitor it, how it would work," he said. "Same with safe supply. Some of the criticisms about diversion are probably legitimate, but it is because we need to do a better job of how we do safe supply, not because safe supply is a bad idea."
Speaking on CBC Thursday, Tyndall said the changes effectively kills the program. Osborne disagreed Thursday. She said the program has helped individuals get treatment, get jobs and reconnect with family members.
Tyndall's argument rests in part on the new practicalities of the changes, the key one being of moving to a witness-only model of administering alternatives for new participants. Existing participants will see a transition period toward the new model. Tyndall acknowledged the transition period, but questioned whether it would succeed.
"Practically, speaking people need to use these drugs, three, four, five, six times a day," Tyndall said. "So it's totally impracticable to expect them to line up at a pharmacy that many times a day. It just won't work and people just won't do it."
Even if individuals just have to line up once, many will find this procedure tiring before dropping out, he added in pointing to past experiences with witnessed methadone programs.
Osborne said Thursday said many of the 3,400 individuals participating in the program are already part of witness-only programs in pointing to the existence of multiple delivery models.
"Some people visit a pharmacist every single day to have their consumption witnessed," she said. "But there are different types of medication. Some of them are up to four pills a day, but then there are patches that...last two to three days," she said. "That is the work that we have to do with people who are currently not on witnessed consumption, to move them into a program."
Osborne said government will work carefully with various providers across the province in transitioning toward witnessed-only consumption. "So it will take weeks to months and we will work with everybody to do that transition," she said. "We want to do this carefully and thoughtfully and in a way that puts the patient first."
B.C.91裸聊视频檚 new policy reflects recent recommendations by Addiction Medicine Canada, a group of addictions clinicians, who urged the province to adopt a supervised model.
Group member Dr. Robert Cooper, an addictions doctor and family physician in Toronto, said last month that 91裸聊视频渨idespread91裸聊视频� anecdotal reports alleging inappropriate use of prescribed opiates required such a policy shift.
The move has drawn support from the B.C. Association of Chiefs of Police and a number of political commentators, including Martyn Brown, former chief of staff to former Premier Gordon Campbell.
"It's about time and there should be a publicly inquiry, because how many people have the NDP indirectly killed by actually allowing these drugs to be put on the street, that are actually offered by (the) B.C. government and B.C. taxpayers in essence, supposedly in the name of safe supply," he said on the CBC Friday. "But really, what it has done, it has dramatically escalated the drug crisis and problem."
Opposition has come from the B.C. Greens and former chief coroner Lisa Lapointe.
Tyndall said the public is frustrated about the lack of progress around drug-policy related issues.
"They kind of push back, say, 'well, everything you are doing is not working, so let's just stop everything' and that is probably not a reasonable thing," he said. "But I think these kinds of public attitudes...cycle through and right now, we seem to be in an anti-help kind of space, but hopefully that will come around again."
