B.C. expands access to safer drug alternatives for people at risk of overdose

Vancouver–British Columbia's mental health and addictions minister has announced a new policy that will expand access to safer prescription drugs for people at risk of overdose and death from toxic substances, without expecting them to enter treatment.

Sheila Malcolmson said Thursday that people who have been clinically assessed will get alternatives including oral opioids to replace illicit drugs that could be laced with potentially deadly fentanyl.

"B.C. is leading the country as the first province to offer safe supply, and we have had to introduce prescribed safe supply carefully, responding to the urgent need for solutions,'' she said.

There have been more than 7,000 fatal overdoses since a public health emergency was declared in the province in 2016, with the number of deaths hitting record levels during the pandemic.

Alternatives to illicit drugs include fentanyl patches already being used, and for the first time fentanyl tablets, as well as expanded use of injectable and tablet hydromorphone in clinical settings—and a doctor's referral won't be required.

The changes are in line with the federal Controlled Drugs and Substances Act, which requires prescriptions for the alternative safer supply being offered in B.C., which has been lobbying Ottawa to decriminalize the possession of small amounts of drugs for personal use to reduce the stigma of substance use.

"Once fully implemented, more people who use illicit drugs can be prescribed a broader range of safer alternatives, covered by PharmaCare, including a range of opioids and stimulants as determined by each program and prescriber,'' Malcolmson said.

The approach will be phased in over three years.

The program will be available through clinics that currently prescribe safer drugs, and more facilities are expected to be added after health authorities provide implementation plans by end of the month for the policy that Malcolmson said would include rigorous monitoring and an independent evaluation.

"I thank the courageous doctors and nurse practitioners who work tirelessly to prescribe safe supply, who do this work already, and who back this policy,'' she said.

Physicians reluctant to prescribe medications to substance users are expected to be provided with training, Malcolmson said in response to suggestions from drug users and Green party Leader Sonia Furstenau that not all doctors are willing to prescribe drugs as part of the safer supply policy.

Provincial health officer Dr. Bonnie Henry said implementing the policy included discussions with the B.C. College ofPhysicians and Surgeons and one of the revelations of the toxic drug-supply crisis is that there has been some inappropriate prescribing of opioids.

Dr. Henry said protocols established at clinics through health authorities will allow the college to be aware of who is prescribing the alternative medications and doctors should feel supported that it's part of a harm-reduction model to save lives.

The provincial coroners service said 851 people died of suspected drug toxicity between January and May, surpassing the previous high of 704 deaths reported for the same months in 2017 by almost 21 per cent.

Dr. Henry said some safer-supply medications will be more widely available so people will no longer be required to pick up their alternative drugs daily at a pharmacy as the policy is phased in.

"Fentanyl patches, for example, can be replaced every few days, and Fentora, which is a new medication, that's not been used in B.C. at all up until now, probably will need to have stronger restrictions in place at first until we understand the parameters of the drug,'' she of the fentanyl tablets.

While medical-grade heroin has been prescribed for a limited number of people at one clinic in Vancouver based on a European model that began about 30 years ago, it is not part of B.C.'s new policy despite previous efforts for its wider adoption by former provincial health officer Dr. Perry Kendall.