Safer supply ‘ethical way to reduce harms’ for people who use drugs: B.C. review
Posted February 1, 2024 7:10 am.
Last Updated February 1, 2024 8:48 pm.
B.C.’s provincial health officer is calling for the government to not just continue offering people who use drugs prescribed alternatives to the illicit, toxic street supply, but to expand access to help more British Columbians.
This call comes after Dr. Bonnie Henry conducted an extensive review of the current prescribed safer supply program, aimed at increasing benefits and decreasing harms. She is urging the B.C. government and health authorities support PSS and consider different delivery recommendations.
Those are just two of the dozen recommendations, with Henry unveiling the findings of her review on Thursday. It has concluded that “safer supply is an ethical way to reduce harms for PWUD (people who use drugs).”
Prescribed safer supply comes mostly in the form of tablet hydromorphone. The current PSS program separates people who use drugs from the unregulated toxic drug supply.
It was expanded in 2021, and budgeted to run for three years. B.C. was the first province in Canada to introduce this public health program.
Henry is recommending more drugs — even prescription heroin — be made available to those in need.
“We need to have new formulations that meet people’s needs and we know that if we have that, it will engage people more in care and retain them in care,” Henry said Thursday.
Henry’s report says currently, based on evidence that is available, “a safer supply policy can be ethically defended and prioritized.”
She says while they can’t yet say prescribed safer supply is evidence-based, because there simply isn’t enough evidence out there, what is available is promising.
“Evidence alone never tells you what to do. It has to be put in the context and understanding of what’s happening in the community and in the areas around the evidence.”
A dozen recommendations
Her review has made a dozen recommendations to both the government and health authority. They include supporting PSS delivery within the health-care system, with an “aim to reduce inequities and not place unfair burdens on particular” groups, in a way that does not perpetuate stigma or inequities.
The recommendations highlight the importance of working with Indigenous partners and leaders to ensure there are culturally safe supply options, and to “recognize and address the disproportionate impact” that the current unregulated toxic supply has on Indigenous populations.
Partnerships with people who use drugs, prescribers, and Indigenous leaders to develop and implement policies, and evaluate the effectiveness of the overall program are also highlighted in the report.
Henry’s review also recommends considerations around “diverse safer supply models,” including providing PSS in non-health-care settings.
From ‘prescribed safer supply’ to ‘prescribed alternatives‘
Shortly after Henry’s presentation Thursday, the B.C. government announced it would be “taking immediate action” in some areas outlined in the review.
One change is to the name of the program, with the province saying prescribed safer supply will now be referred to as prescribed alternatives, in an effort to “better describe the nature of the program.”
“Separating people from the poisoned drug supply so they can stabilize their lives and begin their own recovery journey is a critical part of our plan to save lives and connect people to care that works for them,” said Minister of Mental Health and Addictions Jennifer Whiteside.
“I’m very grateful to Dr. Henry for her thorough review, and to the doctors, nurse practitioners, front-line health-care workers, and people with lived experience who shared their perspectives and expertise. It will help inform critical changes to the program so we can save more lives and help keep people safe as we also expand access to treatment, so more people can get the help they need.”
In addition to changing the name of the program, Whiteside says the province will work to reduce “the risk of misuse of prescriptions” by expanding medication options to meet the needs of people who are most at risk of toxic-drug poisoning and “making ‘witnessed’ dosing the default for new medications.”
B.C. is also updating its guidance on hydromorphone prescribing for certain patients, the government explains, It adds the Risk Mitigation Guidance for prescribers will be replaced by a new process that will be developed to outline how clinicians can prescribe pharmaceutical alternatives during emergencies.
Lastly, the province says it will work with partners to to develop a provincial child-and-youth substance-use and wellness framework. This framework is aimed at setting “strategic direction for ministries, health authorities, community agencies and others to implement a more responsive and integrated youth substance-use system of prevention and care to improve addictions care for young people.”
The update on the PSS program comes after B.C. saw a record number of toxic drug deaths in 2023.
The BC Coroners Service says there were 2,511 suspected unregulated toxic drug deaths, marking “the highest number of suspected deaths ever recorded in a year.”
That figure is five per cent higher than the number of deaths recorded in 2022, which was 2,383.
