One year into the B.C. government's Prescribed Safer Supply policy, the provincial health officer said while early results are promising, more evidence is still needed. Dr. Bonnie Henry's report did recommend the policy should continue. (The Canadian Press)

By Jordan Davidson

one year in

Dr. Bonnie Henry: more evidence needed, but safe supply policy seeing promising results

Feb 1, 2024 | 2:37 PM

NANAIMO — One year into B.C.’s Prescribed Safer Supply policy, the provincial health authority says the program is working to reduce the harm caused by toxic street drugs.

The new report on a review of the policy comes on the heels of B.C. setting a new record for deaths caused by toxic drugs in 2023 when 2,511 people lost their lives including 116 from the Greater Nanaimo area.

Provincial health officer Dr. Bonnie Henry said during a briefing on Thursday, Feb. 1, the goal of the review is to better understand the benefits and concerns around safer supply and its impact on users, the healthcare system, and the community.

“We want to support healthcare providers and others who care for people who use drugs, and we need to address the underlying determinants of health. Things like stigma and shame, discrimination and racism, particularly, that lead to health inequities experienced by people who use drugs.”

Dr. Henry said this process requires a continued public health approach which is informed by people with lived experience and requires an evidence-based response, but admitted the scientific evidence presented is “imperfect”, and requires additional context.

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The report detailed a dozen recommendations for the BC government and health authorities to follow to help enhance the policy.

Those include providing safer supply delivery within healthcare systems in a fair way which doesn’t perpetuate stigma or systemic or structural inequities, partnering with Indigenous leaders for culturally appropriate and effective supply policies, and recognizing the needs of youths and how to decrease their risks of using street drugs.

Increasing access to treatment, prevention, and mental health services, as well as increasing access to housing opportunities were also included.

Effectiveness
Dr. Alexis Crabtree from the BC Centre for Disease Control, said for prescribed safer supply to be effective, the program has to be able to reach those who need it.

“You need to have a sense of how many people would be eligible. For this report, we used the number 115,000 with an opioid use disorder in this province. We found a fraction of those people are accessing [safer supply]. At the time the report was written, only 4,331 people accessed opioid-prescribed safer supply in that month (April 2023).”

Dr. Crabtree said the number of people with prescribed safer supply has decreased every month since then, with only 4,265 enrolled by November 2023.

Barriers to accessing safer supply include income levels, limited access to healthcare, and users living in rural and remote areas.

Dr. Crabtree also spoke about the outcomes of people using safer supply, admitting it’s a new process.

She said the body of evidence around it continues to grow, with much more to learn.

“This is promising, but there’s not yet strong enough research to say that this is an evidence-based intervention…the research is largely positive about PSS, however, this research and Dr. Henry’s consultations clearly show that hydromorphone tablets, which is the main substance that people are accessing via the policy, is not a substance that is working for everyone.”

Some positive outcomes from people include improved quality of life and stability, reduced reliance on street drugs, fewer overdoses, and reducing the chances of users becoming involved in risky activities such as theft or survival sex work.

Identified benefits for the broader population include reduced influence of organized crime and criminal activity, the diversion of safer supply into the illicit drug market, and the advancement of strategies to address the unregulated drug emergency.

Clinicians surveyed said they appreciated having prescribed safer supply as one of ‘tools in the toolkits’, but also expressed concerns about a lack of follow up care like a detox facility, or treatment facilities having too stringent admission requirements.

Unintended results of prescribed safer supply
While limited experts say more time is needed to fully identify long-term benefits or challenges, some short term consequences have already occurred.

Dr. Crabtree said one common concern about the diversion of safer supply drugs is users may trade, sell, or give it away.

“We know from qualitative research about patients who have accessed PSS, that some of them do share or sell their medication, particularly when they feel those medications don’t act as an adequate substitute to the unregulated drug supply.”

Some motivations identified included supporting others not enrolled with prescribed safer supply.

She reiterated the BC Coroner’s Service said safer supply drugs like hydromorphone were not a direct contributor to toxic drug deaths, being found in only three per cent of deaths in 2023, according to their year-end report.

It also touches on developing a process for people who raise concerns about the policy, both for those who use the program and the broader population.

Those harms may include the safer supply getting to non-intended populations with specific concerns around youth accessing, and eventually transitioning to other substances like fentanyl.

“It’s a significant concern because accessing opioids that are diverted could lead to ongoing substance use that becomes problematic,” Crabtree said. “We have data which goes until late 2022 which shows that the rate of diagnosis of opioid use disorders among youth are not increasing in B.C., and did not change since the guidance was released in 2020.”

The report also found prescribed safer supply was an ethical way to reduce harm for people who use drugs, and based on available evidence.

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jordan@nanaimonewsnow.com

On Twitter: @JordanDHeyNOW