Supplies are seen on a table at an outdoor supervised consumption site in the Downtown Eastside of Vancouver, on May 27, 2021.DARRYL DYCK/The Canadian Press
British Columbia has long been on the leading edge of fighting the opioid crisis, but a proposal this month for another groundbreaking experiment has revealed the outside edges of the province’s policies.
The province’s chief coroner ran into those limits when she delivered a recommendation that aims to save lives from a toxic drug supply. Lisa Lapointe’s panel of experts urged the province to offer at-risk drug users a supply of regulated – and therefore uncontaminated – opioids and stimulants without a prescription.
“The most immediate way to meaningfully reduce the risks of significant injury and death is to ensure people who use drugs are not dependent on the unregulated drug supply,” the panel concluded.
There is no precedent for such broad expansion of the province’s prescribed safer supply program, and the B.C. government did not even pretend to consider it. Ms. Lapointe was at the podium introducing the findings of her blue-ribbon panel when the provincial minister’s rejection letter was shared with reporters attending the Nov. 1 news conference.
“Non-prescription models for the delivery of pharmaceutical alternatives are not under consideration,” wrote Jennifer Whiteside, minister of mental health and addictions, in her letter to the coroner.
It was an extraordinary rebuke to Ms. Lapointe and the death review panel members, who see no end to the misery if B.C. doesn’t expand its current efforts.
But the province is right to draw the line at cutting medical experts out of the loop. Addiction is a disease, and the health care system must be at the centre of treatment.
The province has not lacked the courage to try new tactics in this deadly epidemic. Twenty years ago, North America’s first legal supervised drug consumption site opened in Vancouver’s Downtown Eastside. Three years ago, the province was the first in Canada to prescribe opioids in a bid to steer users away from tainted street drugs. And in January, the nation’s first pilot project that decriminalizes some illicit drugs was rolled out across British Columbia.
Despite those initiatives, the problems have grown. At the current rate, six British Columbians die each day from overdose, typically because of opioids laced with fentanyl.
The death review panel, made up of 21 experts including substance use specialists, regional health leaders, a police chief and B.C.’s representative for children and youth, observed that the best response is more robust prevention, treatment, and harm reduction approaches. But those supports have not kept pace with the need, and their proposal should at least provoke conversations about what else can be done.
Preliminary findings show the prescribed safer supply program reduces the risk of dying, but there are fewer than 5,000 participants. Ms. Lapointe said an estimated 225,000 people in B.C. use illicit opioids or stimulants; of those, an estimated 100,000 have been diagnosed with opioid-use disorder.
At another time, the province might have at least considered expanding that program. It seems this is not that time. This summer, the province began to retreat on decriminalization, after Premier David Eby conceded that British Columbians felt less safe since the exemption took force. This fall, his government introduced legislation to prohibit drug use at outdoor recreation areas and within a six-metre radius of building entrances and bus stops.
The prescribed safer supply program is under review and does not have an assured future. The clinicians who administer pharmaceuticals through the program support it as a necessary intervention but raised concerns, including inadequate social supports and fears the program could fuel new cases of substance-use disorder. Separately, a group of about a dozen addiction specialists has called on Ottawa to require safer supply drugs to be used under supervision, to deter the risk of diversion.
As Ms. Whiteside dismissed the death review panel’s proposal, she also responded to the latest tally of lives lost to toxic drugs in B.C., 175 deaths in September, and a total of more than 13,000 since B.C. declared a provincial health emergency in 2016. “Every day, families, friends and communities are navigating tides of deep grief and trauma in the wake of lost loved ones. No words can soften these losses.”
Condolences are not what’s needed. In lieu of words, the province should build on the things that do work: more robust prevention, treatment, and harm reduction.