As a B.C. cabinet minister offers reassurance about the province’s prescribed safer supply program, a Surrey-based addiction medicine physician is raising serious concerns about diverted drugs.
Dr. Alan Brookstone said he’s worried about the quantity of prescribed hydromorphone, also known under the brand name Dilaudid, that is being resold on the streets to users in need of an inexpensive fix or people who previously had no addiction to opioids at all.
“In my recent experience, I’ve encountered four people who have either been reactivated in their addiction or who have initiated a new addiction to hydromorphone,” Brookstone said in an interview.
“If I’m just one physician and there are many, many physicians out there treating patients in this particular province, my opinion is that the numbers are significant — these are perhaps the canary in the coal mine stories that we’re hearing.”
Hydromorphone is a highly-potent opioid that is used to treat severe pain. In B.C., it is also prescribed to people who are at risk of dying from illicit drugs — particularly fentanyl — as a safer alternative that also helps connect them to the health-care system.
There is no formal method for tracking how much hydromorphone is diverted from the prescribed safer supply program into the black market or for separating it from hydromorphone prescribed for pain.
Since the province launched the prescribed safer supply program in 2021, however, Minister of Mental Health and Addictions Jennifer Whiteside said it has been under constant evaluation by frontline physicians, the BC Coroners Service and the BC Centre for Disease Control. None of their work to date indicates the program is contributing to increased opioid use disorder, she told Global News.
“The coroner’s been very clear that prescribed safer supply is not contributing to toxic drug deaths,” Whiteside said.
“We have spoken to chiefs of police across B.C. as well as the Ministry of Public Safety and solicitor general, and they are not reporting seeing an increase in diverted hydromorphone in seizures and in drug trafficking.”
The province launched its prescribed safer supply program in the midst of the COVID-19 pandemic, in the fifth year of its seven-year public health emergency declared to combat the overdose crisis.
According to the BC Coroners Service, nearly seven people a day die from illicit drugs in the province each day, with more than 11,000 fatalities now on record since the emergency was declared in 2016.
As of March, more than 5,000 British Columbians were receiving drugs through the prescribed safer supply program. Providence Health Care could not confirm the number of patients being prescribed opiates from its own rapid-access clinic, but said it was “in the hundreds.”
Guy Felicella, who battled addiction for decades on the Downtown Eastside and overdosed six times, said recent media and political focus on hydromorphone is disproportionate, if not misplaced. Thousands of people are dying from illicit drugs that aren’t prescribed hydromorphone, and it’s far from the worst drug that’s easily available for purchase on the streets.
“It’s pretty hard for me to grasp how the focus has now turned onto the unintended consequences of the safer supply programs, where you look at the consequences of the illicit drug supply,” he said.
“I could have bought the same amount of Dilaudid on the streets 10 years ago … it’s just been that way forever.”
According to B.C. government records, hydromorphone was dispensed more than 580,000 times between 2018 and 2019 to more than 80,000 patients — before safer supply was introduced.
Felicella, who is now a passionate advocate for people in need of mental health and addictions support, said it doesn’t make sense to say the black market is “flooded” with safer supply hydromorphone, given the number of people participating in the program. He doesn’t dispute that it happens, however.
“Prescription opioids are prescribed Canada-wide by the truckloads,” he said. “Nobody was mentioning diversion for a long time except until the risk mitigation guidelines came out, and it was given to substance users as a way to support them.
“You have to look at organized crime instead of programs we’re trying to implement through health authorities. I bet you organized crime is just sitting back, laughing — ‘Look at these guys, they’re arguing about prescribed medications while we’re just selling them by the truckload to everybody.'”
Dr. Paxton Bach, an addiction medicine physician at St. Paul’s Hospital and co-medical director of the BC Centre on Substance Use, said it’s frustrating that the conversation on hydromorphone diversion has become “very politicized” and “oversimplified.”
The topic has been recently raised by the BC United Official Opposition and federal Conservative Leader Pierre Poilievre.
Concerns about diversion are valid, he added, and the BC Centre on Substance Use and other provincial bodies knew of those risks when the safer supply program first launched. It developed guidelines to help physicians evaluate them before deciding to prescribe.
It’s a more complicated conversation than whether it is or isn’t happening, Bach added, but whether diversion is harming people.
“The intended consequences of safer supply prescribing are to disengage individuals from an increasingly toxic and volatile drug supply, but there will be many unintended consequences as well,” he said.
“Trying to gather a complete picture of all of those unintended consequences, good, bad and other … is far more complicated than some individual anecdotes.”
Bach said there’s room for improvement in B.C.’s safer supply program, which was rolled out relatively quickly to stop people from dying in the midst of a crisis, in isolation during the pandemic.
Charging patients a nominal fee for drugs may reduce the profit of a street sale and discourage diversion, he suggested, while offering the substances in a more barrier-free setting — without having to travel, become a patient and obtain a prescription — may bring more users into the safe supply fold.
Brookstone said he doesn’t believe the current model is working at all, not having observed a decrease in toxic drug deaths since it was launched. He said he’s not alone in his opinions either, and while Global News has reached other physicians with similar concerns, none agreed to an interview on the record.
“We need an environment that’s safe for (users) to live in, to learn in and to be treated in so that we can actually achieve long-term recovery and get these people back to productive life,” he told Global News.
“I think we need a far more comprehensive wraparound service for these patients.”
Brach said he believes prescribed safer supply is “strongly benefitting” some of his patients, but not everyone.
Felicella said he’s seen it work for “lots of people” by giving them a chance to stabilize their lives, without having to worry about whether their use will lead to overdose.
Whiteside said the province knows it has more work to do, and in addition to offering safer supply, continues to invest in more housing, treatment beds and programs that treat and prevent mental health and addictions challenges. The ministry is still “amassing evidence” to prove reduced mortality among participants in the prescribed safer supply program, she added.
“What is very critical right now is that we separate people from the toxic drug supply and that is the primary objective of the prescribed safer supply program,” Whiteside said.
“It’s one tool that we have amongst many other tools in order to really try and turn the dial on what is an unrelenting crisis.”
— with files from Paul Johnson
The BC Alcohol and Drug Information and Referral Service is available 24/7 to connect those affected by drug and alcohol use to counselling, toll-free at 1-800-663-1441.
Information on harm reduction services and overdose prevention is available on the B.C. government’s website.
A map of safe injection sites and free naloxone pickup locations, and other resources for users, caregivers, and concerned friends and family, are available on the Toward The Heart website.
Editor’s Note: This story was updated on Sat. March 27, 2023 to include new information from the BC Centre on Substance Use’s opioid use disorder practice update from January 2022.