How does B.C.’s safe supply program work — and is it being abused?

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B.C.’s so-called safer supply program, which provides prescription opioids as an alternative to potentially fatal toxic drugs, has come under fire amid concerns that some of the government-provided hydromorphone isn’t being taken by the patient but sold for street drugs.

Critics say it’s evidence the program is being abused and opens the door for hydromorphone, sold under the brand name Dilaudid, to be marketed to youth at rock bottom prices.

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Harm reduction advocates and public health officials say there’s no evidence that the safer supply program is fuelling new addictions. The biggest problem with the B.C. NDP’s safe supply program, they say, is that it’s not widespread enough, which is leaving people in remote communities without access to potentially life-saving opioid alternatives.

Here’s what you need to know:

What is the safer supply program?

In March 2020, B.C. became the first jurisdiction to roll out a provincewide prescription opioid program that allowed physicians or nurse practitioners to prescribe pharmaceutical-grade opioids free of charge to people at high risk of overdose. It was launched in the early days of COVID-19 when many in-person support services were scaled back. The aim was to ensure people had an alternative to toxic street drugs that are now killing an average of seven people a day.

How many people are receiving prescribed opioid alternatives?

In February, provincial health officer Dr. Bonnie Henry released a report following a months-long review of the prescribed opioid alternative program. Henry endorsed the program and called for it to be expanded to reach more people across the province.

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According to the report, 4,331 people were given prescribed opioid alternatives, which is less than four per cent of the estimated 150,000 people with a substance-use disorder.

Henry said in the report that many British Columbians are unable to access prescribed opioid alternatives because of limited access to health care in rural or remote communities, or an inability to find a doctor willing to prescribe opioids.

How big a problem is diversion of hydromorphone?

Prince George RCMP said last month that a recent seizure of thousands of pills included morphine and hydromorphone, two drugs that are part of B.C.’s safe supply program.

Vancouver police Deputy Chief Fiona Wilson told a House of Commons committee this week that 50 per cent of hydromorphone seizures in B.C. had been diverted from “safe supply” drugs.

Henry’s report confirmed that “some diversion is occurring,” but added “the extent and impacts are unknown.”

B.C. United addictions critic Elenore Sturko said it’s unacceptable that instead of “benefitting the person who is suffering from the illness” these opioids are “being used as a currency to benefit organized crime.”

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Dr. Paxton Bach, co-medical director at the B.C. Centre on Substance Use, said the diversion of hydromorphone is “a legitimate concern and something we absolutely need to be talking about.”

However, to put that diversion into context, he said, it’s important to consider that “hydromorphone remains a very small part of the overall opioid seizures” by the RCMP.

What do critics say about the program?

Critics of the program, including B.C. United and both the federal Conservatives and B.C. Tories, say the B.C. NDP is keeping people sick by handing out taxpayer-subsidized addictive drugs with no focus on treatment and recovery.

Sturko has called for pharmacists to witness people taking their hydromorphone pills to prevent them from being sold on the street for more toxic street drugs.

The problem with witnessed supply, said Bach, is it’s too onerous for people to come to a pharmacy five times a day to take hydromorphone. People are typically given a maximum of 14 hydromorphone pills a day.

Methadone is consumed under the watch of a pharmacist but Bach said that’s because methadone’s effects are longer-lasting and can be consumed once a day.

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“It’s setting an extraordinarily high bar” for people to access the prescribed opioids, he said.

Bach said it’s an oversimplification to say that by focusing on safe supply clinicians are ignoring long-term options like treatment and recovery.

“The toxic drug crisis is a complicated issue that will require many, many complicated interventions to adequately respond to it and all of the things that are contributing to it,” he said.

What does the research say about prescription opiods? 

A B.C. study published in the British Medical Journal in January found people with addiction who received a safer supply of prescribed opioids were 61 per cent less likely to die than those without access to it.

The peer-reviewed study analyzed 5,882 people who received prescription opioids between March 2020 and August 2021 and compared the number of overdoses and deaths with a similar number of people who didn’t receive a safer supply of drugs.

Bach, a co-author of the study, said concerns about diversion should be offset by these life-saving results.

“So to suggest that everyone who’s participating in these programs is turning around and trading their hydromorphone for fentanyl is very hard to reconcile with the data that we have that suggests this can be really an effective way of reducing one’s overdose mortality risk,” he said.

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Are hydromorphone pills being marketed to youth? 

Dr. Mark Mallet, a Victoria-based hospitalist with more than a decade of experience, wrote an opinion piece in The Globe and Mail last September expressing concern that teens are buying “dillies” and becoming addicted to opioids.

Greg Sword, a Vancouver father, has become an outspoken critic of the safe supply program after his 14-year-old daughter Kamilah died of a drug overdose in August 2022. He told Postmedia News that a coroner report found his daughter had three drugs in her system: cocaine, MDMA and hydromorphone.

Guy Felicella, a peer clinical adviser with the B.C. Centre on Substance Use in Vancouver, said he’s done more than 100 talks to students about drugs and he’s never heard of a youth getting addicted to opioids by taking hydromorphone. He said most kids tell him their gateway drugs were cannabis, alcohol and party drugs like MDMA.

Felicella has become a widely sought after public speaker following his decades-long struggle with heroin addiction. Felicella has been sober for more than 10 years following treatment and recovery but he’s also a staunch advocate for harm reduction measures that will keep people alive.

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“I have challenges with people saying that safer supply, it’s flooded the market, it’s created new addictions,” he said.

It’s counter-productive to focus “on a small safer supply program that pales in comparison to what’s killing people,” Felicella said. “If people are buying those pills … at least they ain’t dying from them.”

kderosa@postmedia.com

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