The toxic drug poisoning crisis was declared a public health emergency in BC in April 2016, and it has and continues to, disproportionately affect communities already experiencing health inequities. Combatting the toxic drug poisoning crisis in BC includes a continuum of strategies and solutions, one of which is prescribed safer supply (PSS).
Safer supply is an evidence-informed intervention that provides alternatives to the highly toxic, unregulated drug supply. The main goal is to reduce overdoses and save lives, while also linking people to care, and taking an intersectional approach that addresses the determinants of health, such as stigma, poverty, mental health, and housing.
In the early days of the COVID-19 pandemic when physical distancing and self-isolation were needed, Risk Mitigation Guidance was launched to enable healthcare providers to prescribe select medications, including opioids and stimulants. This was a critical pandemic intervention and it led to BC’s existing prescriber-based model (i.e., PSS) that was introduced in July 2021. This policy, however, remains limited and has not kept pace with needs.
Recent reports have called for immediate action on lower-barrier and more equitable safer supply measures, as the toxicity and volatility of the unregulated drug supply requires solutions that offer people who use drugs (PWUD) safer alternatives. A recent study found that prescribing pharmaceutical alternatives at a population level is associated with a reduction in deaths in the days immediately following.
Now, BC’s Provincial Health Officer (PHO) has released a review of BC’s PSS program, providing key recommendations for action. The goal is to maximize the benefits and minimize the harms of PSS, including amongst Indigenous peoples who are disproportionately represented in the crisis, providing advice on whether this policy should be continued, and if so, what recommendations should be considered.
This review demonstrates that evidence for PSS is mostly positive, though more evidence is needed across areas such as operational implementation, healthcare and clinical experiences, and the mechanisms of the program itself (e.g., reach, alternative options and distribution systems, and specific approaches to care for Indigenous Peoples, youth, people with chronic pain, and people working in the trades). In addition, understanding what recovery or stability means is different for many, and people must be supported at all stages in their process and journey, and be met where they are and where they are not.
The review makes it clear that the current PSS policy should be continued, with modifications and supportive changes as described in the recommendations. The recommendations are based on an evidence review, stakeholder engagement, and an ethical analysis. Highlights include, but are not limited to, the following (for in-depth recommendations, read the full report):
- Substance use must be understood as a public health issue and through a social determinants of health lens.
- Changes to PSS policy should be made with the recognition that the unregulated supply is rapidly changing.
- Changes to policy must be accompanied by improved access to treatment services and to prescribed alternatives to the illegal market for people who would not choose or are not eligible for treatment for substance use disorder.
- Available opioid and stimulant medication options need to be expanded, with prioritization of diacetylmorphine and fentanyl, and smokeable formulations.
- A substantial investment should be made in evidence-based youth health promotion and well-being.
- Consultation should occur with Indigenous rightsholders; better, more regular communication with the public is needed; and there should be sustained and meaningful engagement of people with lived and living experience of substance use.
The evidence-based recommendations and advice, informed by those with lived and living experience as much as possible, support a public health approach that respects the autonomy of PWUD, addresses determinants of health, stigma, discrimination, racism, and health inequities experienced by PWUD, and supports healthcare providers and others caring for PWUD.
Through Together We Act and our response to the toxic drug poisoning crisis, we offer a way to help move the dial on safer supply. We know innovative action and funding are needed now, and we cannot wait until all barriers are removed before we act. Provided action is evidence-informed and equity-driven, ethical, grounded in values, respects engagement with people with lived and living experience, and collaborative across community and healthcare, there is no reason to delay supporting recommendations from the PHO. Reviews like this are critical to making progress — the recommendations are clear, there is no question of the need for progressive interventions, and we all must learn, and act, together.
