B.C.’s safe supply model only reaching a ‘fraction’ of drug users: former provincial health officer

B.C.’s former provincial health officer says the government’s safe supply model only reaches a fraction of the people who need it – and a different model is needed to stop deaths from the toxic, illicit supply.

Dr. Perry Kendall was the province’s top doctor when the increase in deaths from toxic drugs was declared a public health emergency in 2016. Since then, grim records for lives lost continue to be set, with 2021 seeing the most fatalities ever recorded. The government started prescribing drug alternatives in a new program last year to keep people from dying from the volatile and poisoned black market supply.

Kendall says while B.C. is the only jurisdiction in North America with a safe supply program it’s too hard to access — and that needs to change.

“It’s only reaching a fraction of the people who need it. We need a different model, a public health-based model that looks at regulated access to a wider variety of substances for more people,” he told CityNews.

“If we look at who’s dying, nearly 50 are not people who would meet the criteria.”

RELATED: Drug user advocates say B.C.’s safe supply program still inaccessible, inadequate

Kendall says the challenges of a prescription-based model include the requirement of a diagnosis with substance-use disorder, and doctors who are reluctant to participate in the program. While a range of drugs can be prescribed, Kendall says clean heroin isn’t one of them. He says people with lived experience using drugs want to see medical-grade heroin offered more widely.

Cheyenne Johnson with the B.C. Centre on Substance Use says people are mostly getting opioids from the program, specifically, drugs used for treating opioid-use disorders. She notes that the medicalized model is not what drug users have been fighting for.

“Prescribed safer supply is a harm reduction intervention. Its roots are grassroots. It’s really been developed by people who use drugs and people who are at most risk of overdose,” she said.

“The current model in British Columbia involves utilizing physicians and nurse practitioners to access pharmaceutical-grade supplies of opioids and other medications to reduce people’s risk.”

She notes this poses challenges for people who don’t have a prescribing professional in their community, or who mistrust institutions. Further, she says there just isn’t a solid foundation for its expansion.

“We’re trying to mount an emergency response for overdose on the backs of a non-existent substance use system of care. So that creates many, many challenges in access and support.”

On Wednesday, a report released by chief coroner Lisa Lapointe called on the government, the BC Centre for Disease Control, and the BC Centre on Substance Use to find a way toward a safer supply of drugs — that would include both “medical and non-medical models.” The report looked at 6,007 deaths between August 2017 and July 2021 and found increasingly toxic drugs — coupled with a policy of prohibition — forces reliance on an increasingly volatile and poisoned supply of street drugs.

“Illicit drug toxicity is the leading cause of unnatural death in B.C., more than homicides, suicides, motor vehicle incidents, drownings and fire-related deaths combined,” according to the report.

“Although a number of provincial initiatives have been undertaken in an attempt to address the drug toxicity crisis, these initiatives have not been sufficient to stop the rising death toll.”

RELATED: ‘We don’t have time’: Vancouver drug user advocates want swift action on safe supply recommendation

VANDU and the Drug User Liberation Front (DULF) have applied to Health Canada for an exemption to the Controlled Drugs and Substances Act, in order to be able to run compassion clubs that distribute cocaine, heroin, and methamphetamine in tested, clean, and predictable compounds.

Kendall says these clubs would eliminate the requirement for a diagnosis and ongoing monitoring. They could be staffed by nurse practitioners and people who use drugs, instead of relying on doctors who specialize in addiction medicine. They have precedent in, for example, cannabis compassion clubs for people with HIV/AIDS.

“That is a model that could be explored and monitored very carefully, and if it was proven to be effective and had more benefits than harm — could easily be expanded … We should be funding that tomorrow and enrolling several hundred people in it and monitoring it very carefully,” he said.

“If we’re going to seriously reach a large number of people, particularly people who don’t meet the opioid substance use criteria, then we need to explore other models.”

RELATED: Vancouver councillor, advocacy groups distribute drugs to highlight toxic drug supply concerns

Ultimately, Kendall says the prohibition of drugs and the criminalization of those who possess, use, and sell them is driving this crisis.

“The legal framework is not a public health-oriented framework. The damages of the legal framework are what we’re seeing now, which is a large black market, criminals making profits from it. And unfortunately, thousands of people dying every year,” he said.

“I think we should have a serious adult conversation about why some drugs are illegal, why some aren’t — and the harms that that regulatory regime is currently causing.”