A mySafe narcotic dispensing machine is seen at the Overdose Prevention Society as Vancouver's local health unit in the Downtown Eastside of Vancouver, in April, 2020.JESSE WINTER/Reuters
Over the past year, British Columbia’s NDP government has gone out of its way to downplay concerns about diversion of opioids that are dispensed through its safer supply program, even going so far as to enlist RCMP brass to tell the public that the issue is overblown.
But a leaked report prepared by investigators in the provincial Ministry of Health found that large quantities of opioids distributed through the program to people with addictions are not being consumed by the intended recipients. Some of those pills end up in the hands of criminal gangs. Some are being trafficked in B.C., Canada and internationally.
Last June, a special investigative unit within the Ministry of Health launched a probe into diversion. The team delivered a confidential briefing for their policing colleagues on Jan. 9, detailing how 60 pharmacies are believed to be offering patients prohibited incentives for their prescription business to maximize the amounts they can bill the province’s publicly funded drug plan.
What happens to that supply, according to investigators, is especially troubling.
“A significant portion of the opioids being freely prescribed by doctors and [dispensed by] pharmacists are not being consumed by their intended recipients,” according to the slides prepared for the briefing. “Prescribed alternatives are trafficked provincially, nationally and internationally.”
In response, Health Minister Jody Osborne is promising to act swiftly on what she describes as new information.
B.C. launched its safer supply program in March, 2020. Those prescribed opioids are intended to provide individuals with an opioid-use disorder, who are at high risk of overdose or poisoning owing to toxic street drugs, with pharmaceutical-grade opioids prescribed by a physician or nurse practitioner.
B.C.’s auditor-general has noted that there was no medical evidence to support such an initiative, and that concerns about the potential harm due to diversion – prescribed opioids ending up on the street – needed careful study. “Prescribed safer supply is intended to be an evidence-generating program, and evidence gathered through evaluation is crucial to the program’s continuation,” Michael Pickup wrote in a report published March, 2024.
To date, the benefits of the program remain murky – because the government has not produced robust data. Addiction Medicine Canada, a group of addiction medicine clinicians, wrote to Ms. Osborne in January, pointing out that there have been no controlled trials to evaluate the program, while the amount of prescribed opioids from the program that are being diverted has not been formally studied.
Concerns about diversion ramped up after the province started dispensing prescribed alternatives. Last spring, RCMP in Campbell River and Prince George announced drug busts that they said involved large quantities of prescribed opioids that were being diverted into drug trafficking operations involving organized crime groups.
B.C. RCMP Assistant Commissioner John Brewer seemed to pour cold water on those findings, issuing a statement saying “the presence of confirmed safer supply prescriptions are in the minority of drug seizures.”
Pay attention to his language: this can’t be “confirmed,” because the province has not provided a mechanism to mark opioids prescribed under the program in a way that would let police to distinguish them from other prescribed opioids.
From 2022 to 2024, the program dispensed an estimated 2.7 million doses of morphine, fentanyl and oxycodone. Initially, most of that supply was consumed in front of a medical professional, but that is no longer required in most cases.
The total number of opioids prescribed, mostly for pain management, is much larger. Roughly 25 million doses were given out in that time period, and the government does not identify those drugs handed out under safer supply as distinct from the rest of the opioid prescriptions. So when the province says there is no evidence of widespread diversion of prescribed opioids, it is because it chose not to find out.
Ms. Osborne has promised to take action. She is, rightly, focused on the role of some pharmacies in diversion.
But she can, and should, do more. B.C. needs to restore witnessed consumption. Drugs distributed under the safer supply program need distinguishing features. And, the province needs to collect clinical data around the harms and benefits of the program, so that it can – however belatedly – base its decision on evidence, not wishful thinking.