B.C. moves to dramatically increase access to safe alternatives to illicit drugs

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British Columbians who use illicit drugs on even an intermittent basis could soon be eligible for pharmaceutical alternatives as the province significantly expands access to a “safer supply” to combat record overdose deaths caused by toxic street drugs.

Provincial Health Officer Bonnie Henry issued a public-health order on Wednesday that, coupled with forthcoming policy changes, will allow registered nurses and registered psychiatric nurses to prescribe, make more medications available, and expand eligibility to people who are at risk of overdose, including those who may not necessarily be diagnosed with a substance use disorder.

“We know the pandemic has only made the street drug supply in B.C. more toxic than ever, putting people who use drugs at extremely high risk for overdose,” Dr. Henry said in a statement. “Giving physicians and nurse practitioners the ability to prescribe safer pharmaceutical alternatives has been critical to saving lives and linking more people to treatment and other health and social services.”

Other provinces have been less willing to embrace harm reduction measures despite surges in overdose deaths. Alberta, which recently closed one of the country’s busiest supervised consumption sites, emphasizes detox and recovery. Saskatchewan’s Health Minister said his government’s role is to “provide counselling and addiction treatment and addictions treatment beds as opposed to free drugs,” the Saskatoon StarPhoenix reported.

B.C.'s new measures constitute the province’s most significant effort to date to directly address a contaminated illicit drug supply responsible for the majority of about 6,000 overdose deaths since 2016, the year a public-health emergency was declared.

As the COVID-19 pandemic exacerbated the overdose crisis – with disrupted drug supply chains resulting in even more toxic drugs, and harm reduction services curtailed – B.C. opened the door to the “safer supply,” allowing doctors to prescribe take-home doses of various pharmaceutical alternatives.

However, many doctors were reluctant to prescribe for this purpose, which meant many people who could benefit from these medications had no way of accessing them.

In May, Dr. Henry acknowledged the hurdles and said the province was working to address the issue. In August, federal Health Minister Patty Hajdu wrote to her provincial and territorial counterparts, as well as regulatory colleges, urging them to do all they could “to help provide people who use drugs with a full spectrum of options for accessing medication.”

The B.C. changes announced Wednesday mean that more health professionals will be able to facilitate this connection, and make clear that there no longer needs to be a COVID-19-related risk. Anyone who is at risk of overdose should be able to access these medications.

A policy directive by the province’s Ministry of Mental Health and Addictions, Ministry of Health and Office of the Provincial Health Officer is still being finalized. It is expected to include more details on who is eligible and which medications will be added to the program. It is also expected to allow for medication dispensation from health authorities and community pharmacies.

The expansion of the eligibility criteria to include people who use drugs only on an intermittent basis is notable. A report released in 2019 by Patricia Daly, Chief Medical Health Officer at Vancouver Coastal Health, reviewed the circumstances of hundreds of overdose deaths and found that, of 261 people who died, almost all from opioids, just 39 per cent used opioids daily.

Dr. Daly said the finding was surprising and underscored the need for a regulated supply because conventional treatments such as methadone or Suboxone, which are taken daily, may not capture – or be appropriate – for this population.

Currently, medications such as hydromorphone tablets are being offered as an alternative to heroin or fentanyl, with dextroamphetamine (trade name Dexedrine) an alternative to stimulants such as methamphetamine or cocaine.

Guy Felicella, a peer clinical adviser with both the BC Centre on Substance Use and the Overdose Emergency Response Centre, said the changes are the first step in undoing decades of harm caused by bad drug policy, and show that policy makers are listening to people on the ground.

“Now the work begins on what drugs are available, what drugs we can access,” Mr. Felicella said. “I’ve always said we cannot continue to give drug users the least-sought-after drugs and expect them not to access the contaminated supply.”

Judy Darcy, B.C.'s Minister of Mental Health and Addictions, said the province has more than doubled the number of youth and young adult treatment beds, made investments in child and youth mental health, and has expanded access to counselling. Wednesday’s announcement, she said, is about working on all fronts.

“There are many pathways to hope, but people do need to be alive in order to access them,” she said. “This is harm reduction, but it … also opens the door to being connected to the health care system, to rebuilding your health, to getting social supports, to getting on a pathway to healing and a pathway to recovery.”

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