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B.C. government pledges pharmaceutical drug supply for users, addicts

Overdose death rate continues fatal upward trajectory across province
Emergency responders tend to a drug overdose. The news of the provincial government's pledge to provide pharmaceutical drug supply to users comes two weeks after the B.C. Coroners Service said at least 160 B.C. lives were lost to overdoses in May, the second highest rate since May 2020.

B.C.’s government will provide drug users with pharmaceutical alternatives to highly toxic illicit drugs without expecting people to enter treatment in order to reduce drug overdose deaths.

”British Columbia is in the sixth year of an overdose emergency and with more than 7,000 lives lost,” Minister of Mental Health and Addictions Sheila Malcolmson said. “It is tragic.”

She said a “groundswell of collaboration” has contributed to the news policy that will offer user access to drug options covered by Pharmacare. 

“We are working hard to offer people options,” Malcolmson said. “This new policy will help save more lives.”

The news comes two weeks after the B.C. Coroners Service said at least 160 B.C. lives were lost to overdoses in May, the second highest rate since May 2020. That brings total lives lost in 2021 to 851, the most ever reported in the first five months of a year, surpassing the 704 deaths reported in January-May 2017 by almost 21%. 

Eligibility criteria under new policies focuses on separating people from the toxic drug supply.

The government said health authorities must support the policy through development of clinical settings to provide prescribed safer supply. Further, prescribers must participate in evaluations.

Further, programs and services must be supported by medication protocols and clients will not be required to engage in opioid agonist treatment or other treatment types. 

Pharmacy services related to providing these prescription drugs will be covered through Pharmacare.

When fully implemented, drug users who are at high risk of dying from toxic supply will be able to access alternatives including a range of opioids and stimulants as determined by programs and prescribers.

The program will be funded through a 2021 budgeted amount of $22.6m over three years, with an initial focus on a range of opioids including fentanyl patches, Femora, injectable hydromorphone and tablet hydromorphone.

Other medications would be considered by individual programs based on people’s medical needs, Malcolmson said.

However, B.C. Green Leader Sonia Furstenau said, “This new policy is a small step in the right direction when what we need is a leap.

“Ultimately, the province is still relying on a prescriber model that puts barriers between drug users and a safe supply. It will not be enough to drastically reduce the deaths from the toxic street supply,” Fursteanau said. 

“Many doctors are not willing to prescribe safe supply and consider harm reduction outside of their scope. This is heightened outside of the Lower Mainland, where prescribers are few and far between,” Fursteanau said. “Add to this the shortage of family doctors across the province, and the stigma that those who use drugs face in the medical system.”

Implementation in phases

New policy implementation plans are due back from health authorities at the end of July.  The first phase will last 18-24 months, during which health professionals will determine what does and does not work.

Capacity won’t be known until those plans are returned.

The new approach was arrived at through consultations with clinicians, drug users, indigenous partners, health authorities and other health system partners and regulatory colleges and professional associations.

The ministry said case studies have found that giving people fentanyl patches, creating stability due to access to a regular and safer supply, leads to:

• a reduced number of overdoses and hospitalizations;
• reduced or no illicit drug use including both opioids and stimulants;
• improved connections with primary care services including treatment for injuries and other health concerns;
• overall improved health and wellness, including access to housing and income supports; and
• improved living conditions and improved social connection including reconnection with family and friends. 

Provincial health officer Dr. Bonnie Henry said the response to the COVID pandemic hampered efforts to save lives in the opioid crisis.

But, she said, expanding safe supply over the past two years had provided some relief.

And, she said, with addiction, connection is so important. 

“This is another way we can connect people to the health care system,” she said.

Further, she said connection would help reduce the chaos in addicts’ lives and perhaps open them up to treatment options.

She said substance use must be viewed as a health condition for which a holistic approach to recovery is needed.

First Nations Health Authority (FNHA) acting chief medical officer Dr. Shannon McDonald said the authority approves new approaches to dealing with the crisis that has inordinately impacted indigenous people.

“For First Nations people, there is a risk of inconsistent approach across the province,” she said, suggesting the need for patience in rolling policies out. “FNHA looks forward to working closely with the provincial government . . . to ensure this new program meets the needs of First Nations people.”

Doctors of BC president Dr. Matthew Chow said doctors look forward to increased actions aimed to reduce the harm and deaths from illicit drugs. 

“This ongoing crisis has had lasting detrimental impacts on people who use drugs, their families and communities, first responders, health-care providers and the health system,” Chow said. “These actions are urgently needed."

The overall rate of deaths due to toxic illicit drugs now stands at 39.3 per 100,000 residents with every health authority recording a death rate greater than 33.6 per 100,000 residents, surpassing the previous high established in 2020.

Toxicological results released in June indicate the variability of the drug supply continues to pose a threat to substance users, as 27% of the samples tested in April and 25% of samples tested in May contained extreme concentrations of fentanyl.

Carfentanil, a more potent analogue of fentanyl, has now been detected in 75 deaths in 2021 after being identified in 65 investigations in all of 2020. 

Additionally, 60% of completed tests in May were positive for benzodiazepines, which create significant life-saving challenges for first responders when used in combination with opioids. ͞

Chief coroner Lisa Lapointe said with the COVID-19 pandemic winding down, the province must turn attention to combating B.C.͛s other public health emergency with the same sense of urgency.

“We need to ensure that safe alternatives to toxic illicit drugs are available throughout the province and that we are taking meaningful steps to reduce stigma and offer substance users access to the supports they need and are seeking,” Lapointe said.

Lapointe in November 2020 encouraged clinicians to support those at risk of overdose by prescribing safe supply. She said her service continued to advocate for an accessible, evidence-based and accountable treatment and recovery system for drug users.

Provincial health officer Dr. Bonnie Henry had already last September authorized registered nurses and registered psychiatric nurses to prescribe pharmaceutical alternatives to street drugs.
Prior to that, only nurse practitioners and doctors could prescribe drugs, including substitute medications for illicit-drug users.

Victoria Safer Initiative, AVI Health and Community Services project director Heather Hobbs said providing pharmaceutical alternatives saves lives. 

“Safer participants consistently report that they are experiencing health and social benefits,” Hobbs said. “Providing pharmaceutical alternatives is part of increasing equitable access to health and well-being and moves us all closer to the social justice goals of drug user liberation."

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