Skip to main content
Welcome to
super saver spring
offer ends april 20
save over $140
Sale ends in
per week for 24 weeks
Welcome to
super saver spring
per week for 24 weeks
save over $140
// //

A user displays their 'safe supply' of opioid alternative Dilaudid, provided by the local health unit as a pharmaceutical alternative to deadly street drugs, in the downtown eastside of Vancouver, on April 6, 2020.


Corey Ranger had just taken a leave from his regular nursing duties to provide full-time health care at a growing homeless encampment in Victoria when the B.C. government opened the door to “safe supply” for drug users.

The provincial announcement in late March meant that people at risk of overdose could now be prescribed a take-home supply of a pharmaceutical alternative to deadly street drugs – a move spurred by heightened overdose risks associated with the COVID-19 pandemic.

At the Topaz Park encampment, Mr. Ranger, a registered nurse with AVI Health and Community Services and the Victoria Inner City COVID Response team, added another task to his long list of duties. On top of wound care, overdose reversals and COVID-19 screening, he would inquire if campers wanted, and qualified for, safe supply – also referred to in some government literature as “pandemic prescribing for risk mitigation.”

Story continues below advertisement

If so, he would then contact their primary health care providers.

“I remember calling this guy and he laughed at me: ‘I’m a recovery doctor, not a Dilaudid doctor,’ ” Mr. Ranger recalled. Dilauded is a trade name for hydromorphone, an opioid that can be prescribed as a replacement for heroin or fentanyl.

“Okay, what do we do now?” Mr. Ranger said of hearing the response.

The green light to prescribe a safer supply, made possible by changes to the federal Controlled Drugs and Substances Act and provincial prescribing guidelines, was heralded by drug-policy experts as a significant step toward tackling an overdose crisis that has killed thousands largely because of a highly contaminated illicit drug supply.

But the rollout has been halting. A reluctance by many physicians and nurse practitioners to prescribe, in part because of liability concerns, means people who could benefit from these regulated medications have no way of accessing them.

In the two months since the announcement, about 450 people are confirmed to have been prescribed pharmaceutical alternatives to illicit drugs under the new guidance, according to health-authority data. Of those, roughly 400 are in the Vancouver Coastal Health region and 50 in the Island Health region, while the northern, Interior and Fraser health authorities did not provide The Globe and Mail with any numbers.

PharmaNet, the database that records every prescription dispensed in community pharmacies, shows that 1,294 people were prescribed hydromorphone in April, a 91-per-cent increase from the 677 in March; but the province is still parsing the data to determine if the increase is related to uptake of the guidance.

Story continues below advertisement

Ashley Heaslip, an inner city family doctor and medical lead at PHS Community Services Society, said that the guidance on pandemic prescribing – released in March by the BC Centre on Substance Use (BCCSU) – is not yet supported by a broad body of evidence.

“We’re trying to develop that evidence as we go by integrating research and evaluation with programs that are able to provide safer supply prescriptions to individuals," she said.

That puts prescribers on a cautious path as they navigate a novel safe-supply program, with some unsure about the impact on patient safety.

"We want to be part of reducing harm,” Dr. Heaslip said. “That’s the oath we take: ‘First, do no harm.’ It’s at the forefront of any prescriber’s mind to weigh those risks and benefits with any prescription.”

The guidance being directed at physicians also means that a person’s ability to access a safer supply hinges on regular contact with a physician or nurse practitioner.

“So if you don’t have somebody that you can see, who is able to see you in an ongoing way, who feels that it’s appropriate and is comfortable with utilizing the guidance in their own practice, then you don’t have access to this,” Dr. Heaslip said.

Story continues below advertisement

Mr. Ranger said the predicament shows that it is untenable for individual prescribers to serve as the entry points to a safer drug supply. His efforts to connect people at Topaz Park to safer medications required intensive, patient-by-patient advocacy; the person whose recovery doctor laughed at the idea ultimately ended up switching doctors. The effort took about a full day, in all.

“There needs to be a more as-needed type delivery model, where people can go to a consumption site and access a safe supply of drugs, use it while being monitored and not be bogged down by all of the medicalization and barriers that exist in the current guidelines,” Mr. Ranger said.

(Topaz Park was cleared this week as the B.C. government moved to transition campers indoors.)

Dr. Heaslip called the guidance on pandemic prescribing “an amazing first step in a really important direction,” and said the next step will be to develop community-based models to facilitate broader rollout.

Guy Felicella, a peer clinical advisor at the BCCSU, said addictions physicians and inner city doctors may be more open to prescribing a safer supply. But others have told him directly that they are worried about liability, and losing their licences.

“Their training doesn’t allow them to think outside of their scope. They are focused solely on risk aversion," Mr. Felicella said. “What they don’t understand is that by not doing it, they are causing that individual more risks.”

Story continues below advertisement

While it is understandable that prescribers would first want to see a robust body of evidence, B.C.'s current climate, with its dual public health emergencies, does not allow for that, he said.

"You can’t wait for evidence because people die. It’s like fighting a forest fire: Let’s see which way the wind’s blowing before we do anything.”

Mr. Felicella called on the College of Physicians and Surgeons of B.C. to issue a memo to prescribers on the matter.

Reached for comment, spokeswoman Susan Prins said the college does not have expertise on developing novel courses of treatment for addiction, nor does it advocate for one type over another.

“The expectation of any agency that develops clinical guidelines is that they also make available clear directions for use, standards, mentoring and teaching to ensure the end user, in this case a prescriber, is confident in the treatment before administering it,” she wrote in an e-mail.

In a statement provided by the Ministry of Mental Health and Addictions and attributed to Minister Judy Darcy, Ms. Darcy says the safe-supply guidelines were released as soon as possible to keep people safe during the COVID-19 pandemic and that the ministry is listening to feedback from the front lines to update the guidance and develop new models as needed.

Story continues below advertisement

“We know that overdose prevention and supervised consumption sites can offer people a safe, judgment-free place to connect with care including medication-assisted treatments,” the statement read. “We’re looking at how we can continue to build upon these kinds of models and others to make it easier for more people to find a treatment plan that will work for them.”

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.

Your Globe

Build your personal news feed

  1. Follow topics and authors relevant to your reading interests.
  2. Check your Following feed daily, and never miss an article. Access your Following feed from your account menu at the top right corner of every page.

Follow the author of this article:

Follow topics related to this article:

View more suggestions in Following Read more about following topics and authors
Report an error Editorial code of conduct
Due to technical reasons, we have temporarily removed commenting from our articles. We hope to have this fixed soon. Thank you for your patience. If you are looking to give feedback on our new site, please send it along to If you want to write a letter to the editor, please forward to

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff.

We aim to create a safe and valuable space for discussion and debate. That means:

  • Treat others as you wish to be treated
  • Criticize ideas, not people
  • Stay on topic
  • Avoid the use of toxic and offensive language
  • Flag bad behaviour

If you do not see your comment posted immediately, it is being reviewed by the moderation team and may appear shortly, generally within an hour.

We aim to have all comments reviewed in a timely manner.

Comments that violate our community guidelines will not be posted.

UPDATED: Read our community guidelines here

Discussion loading ...

To view this site properly, enable cookies in your browser. Read our privacy policy to learn more.
How to enable cookies