British Columbia’s provincial health officer Dr. Bonnie Henry has revealed her recommendations for a prescribed safer supply program (PSS) that would be for the entire province.
Henry has concluded “through research and evidence” that safer supply is an “ethical way to reduce harm” for people who use drugs, and a provincial program can be ethically defended and prioritized.
Her remarks came as she issued the report including a recommendation that the province increase the range of drugs available to include smokable fentanyl and other substances.
Henry said it was important not to let “rhetoric in the public domain … overcome the evidence that we have that putting people into the criminal justice system because of their drug use is not going to save lives and it’s not going to help them.”
“We need to replace it with the compassion and understanding that I know we have in this province,” she said at a news conference.
Henry said the review stemmed from a series of “listening sessions” conducted with health-care professionals, researchers and drug users.
She said its recommendations sought to maximize the benefits of safer supply programs and mitigate their potential harms in an environment with “imperfect” evidence.
The report says an “ethical analysis” of prescribed safer supply concluded that interventions to reduce certain or severe harms were justified, even if it meant “uncertain harms” to the broader population.
Henry’s review also says the province should stop calling the program “prescribed safer supply,” and instead refer to “prescribed alternatives” to toxic supply.
It also said there needs to be “substantial increases” in supportive and low-income housing because of the link between poverty and homelessness with “problematic” drug use.
The Provincial Health Ethics Advisory Team, which includes ethicists and other health care staff working in B.C. health authorities had its own 12 recommendations as well:
- Support PSS delivery within healthcare systems
- Partner with people who use drugs, prescribers and Indigenous leaders
- Recognize and address the disproportionate impact of unregulated drugs on Indigenous populations
- Recognize and address the needs of B.C. youths
- Expand services regarding health and reducing harms from substance use for people who use drugs
- Evaluate safer supply program effectiveness
- Consider diverse safer supply models including providing safer supply in non-healthcare settings
- Ensure strategies to address diversion reduce negative impacts of diversion without disrupting benefits
- Ensure strategies to reduce diversion address the unmet needs of people who divert PSS
- Provide appropriate support for prescribers of PSS
- Develop processes for people to raise concerns about safer supply policies and services
- Regularly update this ethical analysis to incorporate new evidence
The provincial health officer said she understands that some prescribed safer supply drugs will be diverted to those to whom it is not prescribed, but she said the benefits of the program will outweigh the harm diversion will cause.
“We balance the benefits of PSS with potential harms of diversion, drawing upon the public health principle of utility that seeks to uphold a positive balance of overall benefits to harms; making decisions that promote health and minimize harms as much as possible,” Henry’s report said.
“Effective interventions to address the certain and severe harms from the unregulated drug supply take priority at this time over the potential and even likely harms to the population from diversion.”
The term safer supply should be retired, according to Henry, and the term “prescribed alternatives” should be adopted instead.
“Use of (prescribed alternatives) should situate prescribing in the context of off-label use of prescription medications, which is a routine part of clinical practice,” Henry said in her report.
“Changes to the prescribed safer supply policy should be made with the recognition that the unregulated supply is rapidly changing, and prescribed alternatives should be acceptable as alternatives.”
Henry’s report had some testimonials and stories from those affected by the toxic drug crisis as well.
The report said 4,331 people have access to prescribed safer supply, a small fraction of the at least 115,000 people with opioid use disorder in B.C., leaving the majority of drug users at risk of death from the toxic illicit market.
The B.C. government is set to respond to Henry’s recommendations later Thursday.
More than 2,500 people died from unregulated, toxic drugs in B.C. last year, with fentanyl continuing to be a major driver.
The deadly opioid has been detected in 86 per cent of deaths between 2017 and 2023, according to B.C. Chief Coroner Lisa Lapointe. She spoke on the public health emergency last week.
In December, her office’s expert death review panel vouched for expanded access to safer supply as the “fastest way to reduce deaths” amid the crisis.
The panel said a prescription-free model is the most viable, scalable short-term option to save lives, as an estimated 225,000 British Columbians are currently at risk of drug injury or death.
B.C. Minister of Mental Health and Addictions Jennifer Whiteside has rejected the coroner’s recommendation to adopt a prescription-free safer supply model.
The deadly opioid has been detected in 86 per cent of deaths between 2017 and 2023, according to B.C. Chief Coroner Lisa Lapointe. She spoke on the public health emergency last week.
“Your child, brother, sister, mom dad friend, or colleague did not deserve to die this way. Their death (were) preventable. Their loss — your loss — is our collective loss,” Lapointe said. “How many more families will join these statistics next year?”
In December, her office’s expert death review panel vouched for expanded access to safer supply as the “fastest way to reduce deaths” amid the crisis.
The panel said a prescription-free model is the most viable, scalable short-term option to save lives, as an estimated 225,000 British Columbians are currently at risk of drug injury or death.
B.C. Minister of Mental Health and Addictions Jennifer Whiteside has rejected the coroner’s recommendation to adopt a prescription-free safer supply model but previously said work is still underway to improve access to prescribed safer supply.
The press conference comes exactly one year after B.C. decriminalized small amounts of certain drugs such as opioids, crack, cocaine, methamphetamine and MDMA for personal use.
— With files from Elizabeth McSheffrey and Canadian Press
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