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Opinion: A safer drug supply is a regulated drug supply

"If substance use is the health issue that everyone says it is, then we’ve got to have multiple public health pathways to a safer supply."
How should drug users access a safe supply in British Columbia? Harm reduction advocate Guy Felicella proposes a co-op, or 'compassion club' style approach.

The drug supply is killing people.

This isn’t breaking news. When the province of BC declared a public health emergency more than five years ago following a dramatic rise in overdose deaths, it shouldn’t have been breaking news. For years – decades – we’ve known that people who use unregulated drugs can die simply because we’ve made certain drugs illegal.

So how does this happen? An unregulated drug supply chain controlled by gangs and organized crime, who are driven by profit motives to make drugs more powerful and more toxic. It’s not just opioids. In the 1970s and 80s, cocaine became crack to increase concentration and, key to organized crime, maximize profits. And years before that, thousands of people died as a result of alcohol poisoning under prohibition. Today, fentanyl has become the new heroin. What comes after fentanyl?

In short, what’s killing people is not knowing what they’re consuming. An unregulated drug supply is a deadly drug supply.

Banning drugs doesn’t stop people from using them, it just makes them more dangerous. What’s happening with our current drug poisoning crisis isn’t new, and neither is the solution to prevent deaths: a safer drug supply. Governments are finally waking up to this reality. Alcohol was legally regulated after a disastrous attempt at prohibition in the early 20th century. Cannabis was legalized in Canada in 2018.

And just last month, B.C. introduced a new policy for prescribed safer supply. It’s a step in the right direction, but still not enough to truly compete with organized crime.

Unlike with alcohol and cannabis (and tobacco), prescribed safer supply would see people who use drugs access a regulated supply through the health care system. They would be assessed by a medical professional and then prescribed a small amount before going to a pharmacy to fill their prescription, a process that would be repeated regularly, even daily, for many people. Immediately, you can see the limitations of this approach.

While people would finally know exactly what is in the drugs they’re consuming, having to see a doctor or a pharmacist every day represents a huge barrier. Forget being able to go to work; instead, you’re tethered to the medical system on a daily basis. You would be prescribed a substance at your doctor’s discretion, which may or may not be the substance you want and need. And that’s assuming you can even find a doctor willing to prescribe or have access to a doctor in the first place. For those who can’t or don’t, the unregulated market remains the only option. For those who can’t go to a pharmacy daily, the unregulated market remains the only option.

People who use alcohol, cannabis, and tobacco have multiple pathways to accessing a safe and regulated supply that’s specific to the substance and promotes public health and safety. Someone who enjoys a glass of wine for dinner doesn’t have to go to their doctor for a prescription. Instead, they go to a liquor store or wine seller. If that wine consumption should become problematic? Well, that’s where a doctor comes in, who can focus on treatment and wellness for their patient, not doling out prescriptions for a bottle of Merlot.

The same approach should be taken with opioids, stimulants, and other unregulated drugs. Instead of a prescriber-based approach, we should implement models that allow access to a regulated supply for those who are relying on the deadly unregulated supply.

One such approach would be through establishing co-ops, also known as compassion clubs. People would be screened for eligibility before being granted membership and fees could be based on a sliding scale, both to ensure equitable access regardless of income and to make the approach self-sustaining (e.g. no taxpayer dollars). The drugs available would be what people want and need, including heroin, at a dosing that’s appropriate for them. No more relying on an unregulated supply and wondering if their next fix is going to kill them. Instead, they’ll know exactly what they’re taking, allowing them to use more safely.

We look back at alcohol prohibition as a misguided and complete debacle. Future generations will do the same when they look back on our current drug poisoning crisis.

If substance use is the health issue that everyone says it is, then we’ve got to have multiple public health pathways to a safer supply. Until the drug supply is regulated, the only real option for the majority of people who use drugs will remain the unregulated drug market. And we’ve long known what that means.

Guy Felicella is a Peer Clinical Advisor at the BC Centre on Substance Use. Follow him on Twitter at @guyfelicella.