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Amidst Drug Crisis, Calls for Bold Safe Supply Spending Go Unheeded

The province says 12,000 people have accessed safe supply. That’s wildly inflated, say critics
Members of the Vancouver Area Network of Drug Users have handed out tested heroin, cocaine and meth to demonstrate how a compassion club model for drug users could work to save lives.

Today’s B.C. budget indicates no change in its approach to the worsening toxic drug crisis despite unprecedented deaths and calls for  bold spending to expand safe supply.

An average of seven people are now dying each day, with 2,224 more deaths in 2021. It was the most fatal year recorded after 1,768 deaths in 2020.

The budget  stays the course on current funding plans for treatment and recovery  programs, and does not include new spending for safe supply, which  advocates say has become more urgent in the last year.

It promises $164 million over the next  three years for complex care housing to support about 500 more people  with intersecting mental health, brain injury and substance use needs,  as well as those transitioning out of incarceration and residential  treatment programs.

“This first-of-its-kind  approach will help stop the cycle of evictions, shelters, emergency  rooms and jails for hundreds of people with complex care needs,” said  Finance Minister Selina Robinson from the legislature.

The budget also increases  the Ministry of Mental Health and Addictions’ budget from $21 million to  $25 million for the next three years to keep up with staffing needs. 

Funding for mental health and substance use services is administered mostly through the Ministry of Health.

“Our government is tackling this head on  with the largest investment in mental health and addictions services in  B.C.’s history,” said Robinson. “Despite heroic efforts from those  working on — and working in — this new system, the poisoned drug supply  continues to claim lives.”

Robinson mentioned safe supply, a form of  harm reduction that aims to separate substance users from the poisoned  illicit supply by providing untainted substances, in passing.

The illicit drug supply is now so poisoned that anyone who uses substances even infrequently or casually is at risk.

“Not all drug users have an addiction,”  said Guy Felicella, a peer advisor at the BC Centre on Substance Use,  earlier in February. “We need heroin to be accessible and central to  safe supply, we need to start trying to change policies, not the people  impacted.” 

Last year’s budget allocated $500 million  for mental health and substance use over the next three years. That  included $45 million for harm reduction, including some prescribed safe  supply pilots. Many advocates and experts have called for a non-medical  model of safe supply due to physician hesitance to prescribe many  substances.

The Tyee asked Mental Health and Addictions Minister Sheila Malcolmson last week what evidence supported the idea  that expanding treatment and recovery would reduce deaths.

She said evaluation is “baked into” the 105  new beds being opened and that she would be working on strengthening  monitoring for treatment and recovery facilities, which was largely  deregulated under the BC Liberal government.

“We do have further work underway to make  sure that patients and families can be really confident about the  quality and consistency of care that they’re going to get in treatment  and recovery,” said Malcolmson.

Felicella and public health experts have  cautioned against an approach focused solely on treating diagnosed  addiction, when the poisoned and unpredictable supply makes it  impossible for anyone to know what they are taking. 

The poisoned drug supply also raises the  likelihood of death if someone begins to use again after a period of  abstinence, required by most recovery programs.

“If we can separate people  from it and provide a supply that is regulated, then that will save  lives,” said Chief Coroner Lisa Lapointe in an interview earlier this  month.

In a February media availability, Malcolmson said 12,000 people have received prescribed safe supply since March 2020. 

But this figure includes pharmaceutical  alternatives to illicit drugs aimed at withdrawal management, not direct  replacements. About 30 per cent of these medications were replacement  stimulants and benzodiazepines from March 2020 to December 2021,  according to a statement from the ministry. The remaining 70 per cent  were opioid substitutes like hydromorphone and alcohol withdrawal  substances.

Lapointe, whose office is responsible for  reporting toxic drug deaths, has stressed repeatedly since December 2021  that safe supply “does not exist on a scale commensurate with the crisis.”

“What we’ve tried hasn’t worked, so let’s be brave and bold enough to try something different,” she said. 

When asked why the province is still  pursuing a prescriber-based model of safe supply when doctors and nurse  practitioners have expressed hesitance to prescribe the needed  substances, Malcolmson said she was committed to building the necessary  confidence in the medical community.

“I’m talking with health authorities about  barrier identification, and then working to remove them, and will  continue to use what’s within our provincial jurisdiction, which is  prescribed safe supply,” she said. 

Asked whether the province’s performance  should be judged based on how many people are dying or another way,  Malcolmson did not directly answer.

“Both things are true. The drugs are more  toxic and more people are dying, and we’re building that system of  care,” she said. “We have never had more people working to save lives  from toxic drug poisoning.”

Moira Wyton, Local Journalism Initiative Reporter, The Tyee