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B.C. top doctor calls for more kinds of safe drugs to be available to those in need

Dr. Bonnie Henry says that prescribed safe supply program should be about 91Ƶprescribed alternatives91Ƶ
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British Columbia91Ƶs provincial health officer Bonnie Henry defends B.C.91Ƶs safe supply program, while recommending changes to the program itself as well as other measures to fight the toxic drug crisis, including a call to the province to 91Ƶwork with manufacturers and distributors to expand opioid medication options available to people at risk of opioid overdose.91Ƶ (THE CANADIAN PRESS/Chad Hipolito)

B.C.91Ƶs top doctor says the province91Ƶs prescribed safe supply program is succeeding as one tool to save lives from the ongoing toxic drug crisis, and is recommending that the government expand what substances people are able to access through it.

Dr. Bonnie Henry released her 96-page review of the program on Thursday (Feb. 1), about four years after prescribed safer supply was first rolled out. Henry said that research is still ongoing to determine the evidence-based effectiveness of prescribed safe supply, but that the studies that do exist and the consultations she has done indicate it should be continued.

Beyond this, she also recommended that the province explore additional medical models to expand access and, crucially, non-medical options as well. This approach, which would allow people who use drugs to access a safer supply without a doctor91Ƶs prescription, was also recommended last November by a death review panel convened by the BC Coroners Service.

Both then and on Thursday, the recommendation was immediately shot down by Mental Health and Addictions Minister Jennifer Whiteside.

91ƵWe are not moving to a non-medical model (for safe supply),91Ƶ Whiteside said. 91ƵWe are going to continue to work with frontline providers, with our health care system to improve the current model.91Ƶ

If the province is to stick to medical only models, Henry said it needs to start offering more options of safer supply substances.

91ƵThe medical models, in my recommendation, must be expanded. They must be more of a holistic integrated care model, where you can have91Ƶexpanded access to different medications that meets people91Ƶs needs alongside treatment medications.91Ƶ

Henry added that despite the province91Ƶs rejection her office is currently looking at what the provision of safe supply without a prescription might look like. 91ƵI think there are models out there that we need to look at,91Ƶ she said. 91ƵI think we need to keep this conversation going.91Ƶ She added that her office will be releasing a special report on this in the future.

91ƵIn the meantime, we have many things that we can do that expand the medical model.91Ƶ

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Henry91Ƶs call for an expansion of alternatives also appears in other key recommendation in her report. Henry said that the province should work with manufacturers and distributors to expand opioid medication options available to people at risk of opioid overdose, with priority in supplying prescription heroin and fentanyl, including smokeable versions.

It is not clear yet how much such a program would cost or whether government would agree to it.

Henry91Ƶs report, commissioned in spring 2023, comes one week after the BC Coroners Service confirmed that 2,511 people died from toxic drugs in 2023 91Ƶ roughly seven people dying per day.

The province first started making safer supply available in 2020 when the COVID-19 pandemic coincided with the toxic drug crisis. The program mainly involves prescribing hydromorphone, a morphine-based opioid for severe pain.

As of September 2023, 4,331 people had access to safer supply 91Ƶ a fraction of the 115,000 individuals diagnosed with opioid use disorder. Estimates from the BC Centre for Disease Control, however, peg the number of British Columbians who use unregulated drugs at 225,000.

91ƵGiven the unpredictability of unregulated drugs, each of these 225,000 individuals is at risk of death,91Ƶ Lisa Lapointe, the former chief coroner, said last month.

The safer supply program, which is just one part of a broader response to deaths caused by unregulated drugs, has faced scrutiny by some politicians over the years. They have voiced concern in particular on the issue of diversion, with the possibility of prescribed safe supply falling in the wrong hands or being used to secure harder drugs of unknown quality.

91ƵWe need to recognize that diversion in this context is a recognition of unmet needs, a variety of needs,91Ƶ Henry said.

Whiteside said her ministry will be reviewing the report, but has already implemented some of the recommendations, including changing the name from 91Ƶprescribed safer supply91Ƶ to 91Ƶprescribed alternatives,91Ƶ on Henry91Ƶs recommendation that safer supply means different things to different people.

Other immediately implemented recommendations include reducing the risk of misuse of prescriptions by working to expand medication options, making 91Ƶwitnessed91Ƶ dosing the default for new medications and updating clinical guidance on hydromorphone for select patients.

Whiteside said available evidence shows the prescribed safe supply is 91Ƶhaving a positive impact91Ƶ in pointing to a British Medical Journal study. She said it shows that the prescribed alternatives program reduces the risk of death by as much as 91 per cent in people with opioid-use disorder.

91ƵNow we want to ensure that the program still meets the needs of people at risk of dying due to the increasingly poisonous and unpredictable illicit drug supply,91Ƶ she said.

Elenore Sturko, BC United MLA for Surrey-South and BC United91Ƶs shadow minister for mental health, addiction, recovery and education, sees portions of the report as vindication.

91ƵMonths ago government officials called diversion an 91ƵUrban Myth,91Ƶ she wrote on X, formerly known as Twitter. She then quoted part of the report that reads, 91Ƶemerging evidence indicates diversion of prescribed substance(s) is occurring and may be causing harms.91Ƶ

91ƵAs critic for Mental Health & Addiction, I will continue to advocate for stricter safeguards and recovery oriented practices in BC,91Ƶ she wrote.

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