An SFU professor and critic of British Columbia’s “safer supply” approach to drug deaths is raising concerns with a series of government-produced YouTube videos on how to safely inject drugs.
The videos, which feature harm-reduction advocate Guy Felicella, provide step-by-step directions on how to safely prepare and inject tablet drugs, such as hydromorphone.
The videos were produced by the B.C. Centre for Disease Control, and were intended for an audience of drug users who have been prescribed tablet drugs, but choose to inject them instead of taking them orally.
“It’s really modelling how to consume drugs, and I think that’s really not the message that we need to have foremost in terms of our priorities about keeping the public safe,” Dr. Julian Somers, an SFU Health Sciences professor who focuses on clinical psychology and substance use.
Somers described the videos as “potentially harm-creating,” arguing their presence on the internet makes them accessible to anyone, rather than their intended target audience.
He said people curious about drugs or who are naïve drug users could find the videos, and be led to experiment with injection.
That prospect, he said, was particularly concerning amid allegations hydromorphone prescribed through B.C.’s safer-supply program is being diverted to the streets.
“Here we have a video that is seemingly tailor-made for that demographic, people who might be buying diverted drugs, who have relatively little experience, who are not in a one-on-one relationship with the person providing them the drugs, so they’re not getting access to the information that way,” Somers argued.
“Now it’s putting it into the public domain.”
The BCCDC defended the video series, which it said was created to provide expert-level medical advice to people who use choose inject drugs despite the dangers.
Dr. Alexis Crabtree, a public health physician and the BCCDC’s medical lead for programs and services related to substance use, said the province asked for the videos when it released its clinical guidance for health-care workers prescribing safer supply drugs.
That program provides opioid alternatives to street drugs in tablet form, which are meant to be taken orally.
But Crabtree said the reality is that many drug users will choose to inject the drugs — despite the heightened risk of doing so.
“Some of those harms are just from injection, there’s the risk of infection when people inject drugs, there’s other risks of damage to tissue, and then there’s some specific risks that come with injecting tablet medications,” she said.
“That’s because there’s substances in the tablets that aren’t meant to be injected.”
Crabtree said the BCCDC heard from drug users themselves that they wanted medically-approved guidance on how to use the drugs safely.
But she said there was also strong interest in the videos from addiction medicine doctors, who do recommend the drugs be taken orally, but who also acknowledge that getting long-term drug users to stop injecting “may not be something that’s achievable.”
“That was the context into which we made these videos, to really serve the need, to provide education that is medically-reviewed, about how to use these in the least harmful way possible for people who would choose to inject tablet medication,” she said.
“We heard from addiction medicine clinicians who were really happy to have these videos as a basis for discussion with their patients — they don’t necessarily have the information about how to inject safely and how to use these medications in the least harmful way possible.”
Crabtree said a wide variety of peer-reviewed research has shown that when drug users are provided with information on safer ways to consume drugs they change their injection practices.
That same information has cut down on the number of patients presenting to hospital with infections and abscesses, she said.
It was a message B.C. Minister of Mental Health and Addictions Jennifer Whiteside shared, as she stood by the videos on Thursday.
“Education doesn’t promote drug use, education prevents harms,” Whiteside said.
The debate comes a day after an expert panel led by B.C.’s chief coroner recommended the province massively expand its safe supply program, arguing offering clean drugs without a prescription would be the safest way to cut down on toxic drug deaths.
Whiteside has rejected the advice.
The latest data from the B.C. Coroners Service reports 175 people died from toxic drugs in September, bringing the death toll since the province declared a public health emergency in 2016 to more than 13,000 people.
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