B.C. to review hydromorphone distribution amid concerns

The B.C. government says it will be looking into its safer supply program, including hydromorphone distribution as part of it.

This comes after concerns were raised about the quantity being prescribed in the region, with reports the drug is being resold or traded on the street.

“We are also hearing from clinicians on the front lines that they have increasing concerns, particularly about some patients and prescribed hydromorphone and with the change in drug supply. So the program needs to be reviewed given the situation that we are in right now,” Provincial Health Officer Dr. Bonnie Henry said Monday.

“We are also hearing from people who use drugs that access and barriers remain their biggest challenges. Less than five per cent of the people who use drugs that we know about have had access to prescribed safer supply, and it’s very geographically focused.”

Henry admits this situation is complex, with no simple answer. However, she stresses policy and guidelines must be reviewed and changed “with the best possible evidence” that can be collected.

That evidence, she adds, needs to be “supported by our evolving experience,” including input from people who use drugs, clinicians, and other stakeholders.

She explains while there have been many anecdotes and concerns raised about prescribed hydromorphone, the drug “has been on the street for a long time.” Henry says the majority of prescribed hydromorphone is for pain or other reasons, not related to safer supply.

“We can’t blame it on safer supply because that has been very limited. A very small percentage of the hydromorphone that’s prescribed is under that program. And, yes, it probably isn’t, what we hear from clinicians, that it’s not meeting the needs for some of the clients and the patients in their clinics. So, it is possible it could be used for people to get other drugs that are meeting their needs,” Henry said.

“What we’re also hearing from people who use drugs is that sometimes they use it as a commodity for friends, for others who don’t have access, that they sometimes will save their supply so that if they’re in a place where they don’t have access to drugs for whatever reason, they have something that they can use to help support them through withdrawal symptoms.”

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Despite suggestions that hydromorphone is being used by some people to get access to other drugs, in some cases part of the unregulated supply, B.C. Chief Coroner Lisa Lapointe says there’s been a lot of “anecdotal information and allegations,” which can create challenges.

“Of course, we know that obviously this is a serious health issue and requires a health-focused response. Drug trafficking remains a crime and if there’s evidence of drug trafficking, then law enforcement is responsible for doing what they can to change that trajectory,” she said.

Lapointe says the service has access to records to indicate if they died “of their own safe supply.” However, she notes post-mortem testing has not shown an increase in hydromorphone.

“That doesn’t mean that some of that diversion isn’t happening. But it is certainly being monitored.”

With files from Greg Bowman