British Columbia is moving to provide drug users with a take-home supply of regulated substances as part of its COVID-19 pandemic response strategy for vulnerable populations.
The City of Vancouver and drug-policy experts have called for “safe supply” for some time, but reluctance from regulatory bodies and the province restricted the provision of drugs such as hydromorphone and methadone to clinical settings that require witnessed daily ingestion.
As the new coronavirus swept the globe, health officials issued directives for people to restrict their movements, stay home and self-isolate when necessary, presenting a major obstacle to people with chronic substance-use disorders who are unable to stockpile their prescription medications.
In B.C., the extraordinary circumstance of having two active public-health emergencies – COVID-19 and an overdose crisis caused by a toxic supply of drugs – made safe supply a reality.
Provincial Health Officer Bonnie Henry said the move is particularly aimed at supporting people in places such as Vancouver’s Downtown Eastside.
“These guidelines enable us to provide a safe supply for people and to ensure that they’re able to comply with our public-health advice around isolation or quarantine, should that be required," she said.
The move is made possible by recent changes to the federal Controlled Drugs and Substances Act and provincial prescribing guidelines. Together, they allow prescribers and pharmacists to prescribe individualized take-home supplies of drugs, colloquially called “carries,” and pharmacists to deliver medications and extend or refill prescriptions over the phone.
Eligible patients must be at risk of COVID-19 infection or confirmed positive, have a history of ongoing active substance use, and be deemed at high risk of withdrawal or overdose.
While opioids are the main driver of B.C.’s overdose crisis, the new guidelines extend to other substances, such as stimulants, benzodiazepines, tobacco and alcohol.
Prescribed stimulants include dextroamphetamine (trade name Dexedrine), while benzodiazepines include clonazepam. Those with tobacco-use disorder can be provided with nicotine replacement therapies such as the patch or gum, while medications used to manage alcohol withdrawal include gabapentin and clonidine.
Donald MacPherson, executive director of the Canadian Drug Policy Coalition, said Thursday he was simultaneously delighted and astounded by the development.
“This is potentially a life line for so many in a very strange time," he said. “But the same conditions existed four months ago, eight months ago, two years ago, five years ago. All the calls for safe supply during the last several years of the drug toxicity crisis, and it took a global pandemic to move the dial."
B.C. Minister of Mental Health and Addictions Judy Darcy said the province has been leading the country on the issue for years.
“We were pushing full steam ahead without the second public-health emergency declared, but in this context, the same conditions don’t apply,” she said. “People can’t go to pharmacies, they can’t go to their family doctor or nurse practitioner regularly. … We acted as soon as the federal government said they were prepared to provide these exemptions.”
Ms. Darcy said there is now a push to get the new guidelines out to general practitioners and nurse practitioners across the province “so that this becomes a part of everyday health care.”
Vancouver Mayor Kennedy Stewart said he is hopeful that safe supply can reach the 20 per cent to 30 per cent of Vancouver’s injection drug users who are not part of any prescription drug program and at high risk of overdosing on the contaminated illicit supply.
He said that cities do not have the authority or resources to develop and deploy guidelines around medical care and access to supply and credited partnerships with Vancouver Coastal Health and BC Housing.
Mr. MacPherson said the province’s approval of safe supply now makes its rejection last year of Dr. Henry’s call for drug decriminalization look worse.
“The fact that any of these folks are criminalized at this moment is absolutely absurd,” he said. “COVID-19 has exposed the urgency that has always been there, and it has exposed the absurdity of not prescribing people these substances, and of criminalizing a marginalized, vulnerable population.”
More than 5,000 people have died from overdoses in B.C. since Jan 1, 2016.