Adrienne Tanner is a Vancouver journalist who writes about civic affairs
Last month in B.C., 170 people died after overdosing on toxic street drugs, the highest one-month death toll in our province’s dismal history. This happened despite a decision at the beginning of the COVID-19 lockdown to temporarily allow health professionals to prescribe a “safe supply” of replacement drugs for street drug users.
Although it was sanctioned by all three levels of government, the safe-supply experiment is failing to save enough lives. The overdose deaths in May alone outstripped the total caused by COVID-19 in British Columbia to date.
Only 1,500 drug users have received new safe supply prescriptions. And there are an estimated 20,000 British Columbians buying deadly opioids on the street at great risk of death, says Dr. Mark Tyndall, a professor at the University of British Columbia’s faculty of medicine who specializes in infectious diseases.
The emergency safe-supply plan has been stymied in part because it never had buy-in from key players – the very physicians and nurse practitioners vested with new prescribing guidelines. Many doctors feel torn between what they believe are contradictory instructions coming from the government, telling them it’s all right to prescribe opioids to street drug users, and their own governing body, the College of Physicians and Surgeons of B.C., which has instructed them to dial back prescribing opioids for pain control.
In 2013, when fentanyl first showed up in the street opioid supply and overdose deaths began to climb, doctors were blamed for introducing people to the powerful pain medication. Three years later, B.C.‘s college became the first in Canada to crack down on overprescribing with new standards backed by threats of fines and suspensions to staunch the opioid flow. The rules were initially so tight that patients living with chronic pain complained they couldn’t get relief and in 2018, were loosened a bit.
The prescribing crackdown almost certainly helped prevent new patients from developing addictions. But it did nothing to stop the deaths (more than 5,000 since 2016) of those already addicted and buying contaminated opioids on the street.
Many top health professionals, including Vancouver Coastal Health’s chief medical health officer, Dr. Patricia Daly, and Dr. Tyndall, to name a few, came to believe safe supply and the decriminalization of drugs were needed to save lives. But until March, governments had tiptoed into safe-supply territory with pilot projects, such as the small heroin supply clinic and the one safe supply opioid dispensing machine Dr. Tyndall runs in the Downtown Eastside. It took the COVID-19 pandemic, and the fear of an outbreak sweeping through a population already in poor health, to open the door to safe supply a crack wider.
However, many doctors, having been cowed by their own governing body are understandably reluctant to participate. Among those philosophically comfortable with the program, many lack the specialized opioid agonist treatment training required for them to prescribe safe-supply opioids or replacement drugs, says Sarah Blyth, who founded the Overdose Prevention Society in the heart of the Downtown Eastside. She says it’s hard to find health professionals to write the prescriptions. “It’s been a struggle. Only about one in 20 are willing.”
The college doesn’t sound overly enthusiastic about the safe supply trial. In a statement this week, it says it is interested in exploring efforts to reduce overdoses but doesn’t have expertise in developing novel addiction treatment. “Physicians who treat addiction may well be reluctant to follow the guidelines as there is still limited peer-reviewed literature regarding the potential benefits or harms of safe supply programs.”
That may be true. But we certainly have a clear picture of the harm that befalls people buying tainted opioids on the street. Our governments are calling on medical professionals to get on board. B.C.‘s Addictions Minister Judy Darcy this week opened a hotline to help doctors and nurses with questions about assessing, screening and treating patients who use street drugs and are interested in accessing a safe supply.
Safe supply might not be the most effective way to help people stop using drugs; no one is suggesting it as a replacement for treatment. But it will help keep people alive. Medical professionals around the world are trying umpteen therapies, not all of them tested, to prevent coronavirus deaths. We must treat the overdose pandemic with the same urgency.
We have a weekly Western Canada newsletter written by our B.C. and Alberta bureau chiefs, providing a comprehensive package of the news you need to know about the region and its place in the issues facing Canada. Sign up today.