Police seizures of hydromorphone have climbed in British Columbia since the province moved to prescribe the opioid as an alternative to toxic, illicit drugs, according to Health Canada data.
B.C. implemented the safer-supply model in the early days of the COVID-19 pandemic, prescribing regulated medications to people at high risk of overdose in efforts to sever or lessen their reliance on the volatile street supply. Critics of the program have pointed to the potential for the prescribed medications to end up among the street supply.
Health Canada analyzes illicit drugs seized by law enforcement agencies, and data show that the service identified hydromorphone in B.C. police seizures fewer than 100 times annually from 2012 to 2020, when the safer-supply program began. Seizures of the opioid analyzed by Health Canada then climb each year, reaching 408 in 2023.
Health Canada notes that the drugs analyzed do not represent the total number of substances seized by law enforcement, and the agency has no information on the origins of the substances, such as whether they come from the illegal market or are diverted pharmaceutical drugs.
The opioid still makes up a relatively small amount of drugs seized by law enforcement agencies in the province and analyzed by Health Canada – about 3 per cent. In comparison, fentanyl accounted for 3,828 identifications of the 13,135 samples analyzed from B.C. last year, or nearly 30 per cent.
Across the province, 86 per cent of hydromorphone prescribed is for pain, and 14 per cent as safer supply, for which it is the most commonly prescribed drug to replace illicit opioids such as fentanyl or heroin. The BC Coroners Service said in December, 4,212 people were dispensed opioid alternatives, including 3,656 who received hydromorphone.
The B.C. government has faced calls to better monitor diversion and potential unintended consequences from safer-supply programs. Program staff have described diversion as a “common occurrence,” and Provincial Health Officer Bonnie Henry has said better monitoring is needed.
The issue of potential diversion of prescribed medication has garnered national attention in recent weeks after RCMP in Prince George said it had seized more than 10,000 individual prescription pills, as well as large quantities of suspected fentanyl, cocaine and methamphetamine, over a three-month period. The detachment said in a news release that morphine and hydromorphone ”are safe supply prescription medications,” but the force did not say whether there was evidence linking the seized medications to safer-supply programs.
Critics of these programs, notably Alberta Premier Danielle Smith, seized on the announcement, which she said made her worried diverted medications would end up in her province, while federal Conservative Leader Pierre Poilievre vowed to end the programs.
In a statement, B.C.’s Ministry of Mental Health and Addictions noted that hydromorphone makes up a very small proportion of total seizures and that it is prescribed for many reasons and can be diverted at any point along the supply and distribution chain. The ministry said it is implementing recommendations from Dr. Henry’s recent review of safer-supply programs, including that it expand the types of medications available to better meet the needs of clients, and require witnessed dosing for these medications.
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Victoria physician Mark Mallet said it is “inevitable” that hydromorphone from B.C.’s safer-supply programs would end up in the community given the number of pills being distributed and the fact they are not strong enough to meet the needs of many recipients.
He said he supports prescribing pharmaceutical alternatives to toxic, illicit drugs but that these programs should have better safeguards, such as required witnessed ingestion.
“Maybe someone can’t take the drug exactly when they want, where they want,” Dr. Mallet said. “But I think that is a trade-off that is certainly reasonable.”
Inspector Conor King with the Victoria Police Department said that while the Health Canada data paint a concerning picture about the increase in police seizures of hydromorphone in B.C., the drug accounts for only a tiny fraction of substances seized. And, he noted hydromorphone makes up a greater share of seizures in some other provinces, such as in New Brunswick (at 5 per cent) and Nova Scotia (at 8 per cent).
He said diversion doesn’t appear to be widespread, but health authorities and government should be cognizant of the issue.
“We don’t want to create people who have a substance use disorder by way of safer supply,” said Insp. King, a 25-year veteran of drug enforcement. “At the same time, we can’t lose sight that the drugs that are killing people at heartbreaking numbers are not the safer-supply drugs; they are in fact the toxic fentanyl and fentanyl analogues, combined with dangerous additives.”
Benedikt Fischer, an adjunct professor in the faculty of Health Sciences at Simon Fraser University and a senior drug-policy and public-health scholar, said there is likely diversion of safer supply occurring but that current indicators “do not suggest to me that this has spun out of control.” However, he said there needs to be better data on whether these medications become associated with new cases of opioid use disorder.
“What I’d like to see is that safer-supply medications get marked somehow, whether chemically or pharmacologically or otherwise, so that we can recognize whether it’s in the bloodstream, or whether it’s seized on the street,” he said.
Andrea Woo