BC Rebrands Safer Supply, Pushes Ahead as ‘Landmark’ Study Scrutinized

Provincial health officer Dr. Bonnie Henry speaks in the press theatre at the legislature in Victoria, B.C., on March 10, 2022. The Canadian Press/Chad Hipolito

Health officials in British Columbia are using language and messaging that casts a favourable light on the province’s safer supply approach to drug addiction. This includes moving away from the controversial “safer supply” wording to instead say the province is offering “prescribed alternatives to the toxic supply.”

This change in wording was among the directions British Columbia’s chief medical officer Bonnie Henry gave in her report on safer supply programs published Feb. 1. She said the new wording “prescribed alternatives” associates the program more closely with the common clinical practice of prescribing medications for off-label use.

Messaging from provincial officials consistently includes the words “toxic” and “unregulated” before any mention of drugs responsible for overdose or other harms. “Unregulated fentanyl” was to blame for new record-high overdoses announced on Jan. 24, Chief Coroner Lisa Lapointe said in her report.

This differentiates street fentanyl from safer supply fentanyl—which Dr. Henry’s report said should become more widely available.

The coroner’s report also makes a point of saying safer-supply drugs, such as hydromorphone, are found in only about 3 percent of toxicology reports. This suggests that safer supply is not having a negative impact.

But, as addictions physician Dr. Michael Lester pointed out, critics of safer supply aren’t saying hydromorphone causes overdose directly. They’re saying that hydromorphone is being diverted—sold on the street—and it starts non-users on the path of opioid addiction that leads to fentanyl-use and, perhaps, overdose.

“[Safer supply] advocates point out that there has not been a spike in hydromorphone-caused overdoses since [safer supply] began,” Dr. Lester said in his communications with journalist Adam Zivo, which Mr. Zivo published in-full online as part of a Feb. 1 article for The Hub.

“Many people who start their opioid addiction using oral opioid medications turn to intravenous use or move up to more potent opioids such as fentanyl in time,” he continued. “It commonly takes many years for someone to eventually die of their opioid dependency. It may be a stronger opioid that eventually causes their deaths.”

Many of British Columbia’s published materials on safer supply note the lack of evidence that hydromorphone is causing overdoses. Ms. Lapointe also used such data in a Feb. 1 interview with the CBC to advocate for the expansion of safer supply, including offering it without prescription. Although this information is used to prove lack of harm from safer supply, it doesn’t address the primary concerns raised about safer supply.

In addition to reports from addiction workers that teenagers are getting hooked on hydromorphone, there are concerns that the province is planning to give safer supply fentanyl to minors without parental consent, and that the very companies being blamed for the opioid crisis are being paid to manufacture safer supply opioids.

Top provincial officials have recently made strong statements in favour of both safer supply and the province’s drug decriminalization pilot, which is another hotly contested policy point.

Moving Forward With Decriminalization

Ending decriminalization would “not save a single life,” B.C. Minister of Mental Health and Addictions Jennifer Whiteside said in a statement released Jan. 31, the one-year anniversary of decriminalization.

“Our government’s goal is to reduce the fear and shame associated with addiction, so more people can feel comfortable reaching out for help,” she said. The pilot program is set to last another two years, and Ms. Whiteside said it should continue.

Opposition leader, Kevin Falcon of B.C. United, disagreed, saying decriminalization has enabled the proliferation of drugs and open-air drug-use and that it has contributed to the overdose crisis.

“Instead of saving lives, decriminalization has contributed to a record-breaking loss of life in our province. It has done nothing to increase treatment and recovery services or to protect our most vulnerable citizens,” he said in a Jan. 30 statement.

Both Mr. Falcon and B.C. Conservative leader John Rustad have vowed to scrap decriminalization if either wins the election expected this fall. They advocate for efforts to be focused on treating addiction and increasing the number of recovery beds available.

Move to Address Diversion, Impacts to Youth

Ms. Whiteside noted that the B.C. government is expanding treatment and recovery services as well. Dr. Henry also included in her report some measures to address concerns about safer supply.

“A greater emphasis should be placed on monitoring for unintended consequences,” Dr. Henry said in the report. That includes monitoring for diversion, and also collecting data about youth substance use to see if they are accessing diverted safer supply drugs.

She says witnessed dosing should be the default, and “carries” should only be given for patients to take away “where the prescriber-patient relationship supports a low and managed risk of diversion.”

Dr. Henry proposes the creation of a scientific and clinical committee to review concerns about safer supply.

Critics of safer supply have often said the scientific evidence for the program’s efficacy is lacking. A recent study published in the British Medical Journal last month assessed anonymous health data from British Columbia and said safer supply is promising.

While it was hailed as a “landmark” study, Mr. Zivo’s investigations have cast a critical light on it.

‘Landmark’ Study

The study says recipients of safer supply opioids were 61 percent less likely to die within a week of receiving those drugs, and 55 percent less likely to die of an overdose specifically.

But, doctors who reviewed the study raised major concerns, including that no conclusions about mortality were made beyond one week (long-term), and that the study did not adequately account for other treatments being received at the same time.

The Epoch Times contacted the study’s corresponding author, Bohdan Nosyk of Simon Fraser University, about questions regarding the study, but did not receive a reply as of publication.

One of the scientists peer-reviewing the article for the journal raised the concern that all of the benefits attributed to safer supply may have actually come from the patients’ use of opioid agonist treatments (OAT) at the same time. The reviewer called this a “big issue.”

“When restricting to those not on OAT ... we actually see the results reverse,” the reviewer wrote.

Dr. Lisa Bromley told Mr. Zivo that safer supply was introduced as a public health measure, and the impacts of such on the public as a whole must be considered. The study did not look at diversion.

“Unsupervised distribution of hydromorphone tablets poses risks of harm to others (non-recipients) in the form of new initiations and relapses to opioid use in previously stable people,” she said.