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Henry eyes changes to safe-supply drugs program

Program offers people at high risk of overdose pharmaceutical alternatives to illicit drugs, but some say it’s resulting in opioids flooding the street market
A person receives a tested supply of cocaine in Vancouver in 2022. THE CANADIAN PRESS/Darryl Dyck

B.C.’s top doctor plans to recommend changes to the province’s safe-supply drugs program — a program some critics say is doing more harm than good.

Safe supply is based on the idea that giving people at high risk of overdose pharmaceutical alternatives to illicit drugs in a clinical setting will save lives and give health-care providers a chance to monitor them.

It’s intended to reduce deaths from the toxic-drug crisis, which is killing about six people a day in B.C.

Provincial health officer Dr. Bonnie Henry is set to deliver a report to the provincial government next month, in part looking at whether there should be greater access to opioid alternatives.

It’s expected to include input from people with experience with drug use, harm-reduction workers, physicians, youth and other stakeholders.

“We are seeing very challenging times and we’re seeing harms on a daily basis,” said Henry. “So yes, the program needs to be revised, there needs to be different ways of approaching this that support people and we’re looking at all of them.”

In June, Henry said rather than dismantling the safe-supply program, modifications are needed, with a range of safe additional medications likely made available, along with continued robust surveillance and monitoring.

B.C. is in the eighth year of a public-health emergency in which about 12,000 people have died as a result of an “unregulated” toxic street supply, according to B.C. chief coroner Lisa Lapointe.

Last weekend, Victoria hospitalist Dr. Mark Mallet argued in an opinion piece published in the Globe and Mail that the unsupervised safe-supply program introduced in 2020 has resulted in a powerful, addictive prescribed drug flooding the market and getting into the hands of high-school students — a charge repeated by some federal and B.C. opposition politicians.

Mallet, the father of teenagers, said the most commonly used safe-supply drug is hydromorphone — a potent and addictive prescription opioid sold under the name Dilaudid and commonly called “Dillies,” which some users are giving away or selling.

“The addiction they cause is just as powerful as the addiction to heroin or morphine or any other opioid,” said Mallet.

Lapointe said in June that it’s fentanyl that continues to drive the overdose crisis, and her office has seen no evidence of an increase in safe-supply drugs in the bodies of people who have died of drug overdoses, and it doesn’t appear in “any significant numbers” as a cause of overdose deaths.

But Mallet argues that the drugs people first get hooked on may not be the ones they die from.

Mallet said he supports harm-reduction policies and programs such as supervised-injection sites, free Naloxone kits and free needle exchanges.

When safe supply first arrived in Victoria, he said, it was a small program that made injectable Dilaudid or medical-grade heroin available only to the most entrenched drug users. It was administered in a witnessed setting, typically by a nurse.

“Users could get high, but they couldn’t take the drugs home with them,” said Mallet. “They certainly couldn’t sell them.”

When the COVID-19 pandemic was declared, however, patients were allowed to take drugs home while self-isolating.

“It suddenly became common for users to be given 14 doses of eight-milligram Dilaudid — known as “Dilly-8s” — to take home with them every day,” he said, adding between March 2020 and May 2021, 4,537 British Columbians were prescribed safe-supply Dilaudid.

Mallet said Dilaudid is four to five times more potent than morphine and 25 to 30 times more potent than codeine.

After major surgery, a typical dose is about 1 to 2 mg every four hours, said Mallet. “A single 8-mg dose would render many people unresponsive, and for some it would be enough to kill them.” But for some people who use drugs, they are not potent enough, so they are sold on the street to buy more potent street drugs, he said.

“A patient told me last week that it’s hardly even worth selling his Dillies any more because he can only get 25 to 50 cents a pill,” wrote Mallet.

“That’s how saturated the streets are with Dilaudid.”

Mallet said teens report that Dillies have turned up in high schools and at parties. He said doctors at Victoria’s Cool Aid Society, which serves a large population of people who use drugs, scaled back their prescribing of Dilaudid last year in recognition that too much of it was being diverted.

Cool-Aid would not comment Monday on where its doctors stand on safe supply or on Mallet’s allegation, other than to say in a statement it’s a “challenging issue and we’re constantly reviewing best-practices on this issue.”

Also under review is whether people who access safe-supply drugs must go through the medical system, which can create barriers.

Henry said it’s important to ensure there’s no increased risk to young people, but added: “I think what’s not apparent in what [Mallet] wrote is the work we are doing monitoring where things are going, how much is out there and what is being used.

“What we need to do is develop the program to meet the needs of people and to allow clinicians to make their clinical judgment with the people that they’re caring for,” she said. “So there’s a lot more to come on this.”

She noted that the safe supply is limited and hydromorphone has been on the streets for some time, prescribed for pain not related to the toxic drug crisis.

Mallet maintains there is a strong belief in B.C. that “we can prescribe our way out of the drug-poisoning crisis.”

He said doctors also fear it would be unethical to cut off patients from opioid prescriptions, given the risk they would turn to the toxic illicit supply.

Mallet touts traditional opioid-agonist methadone and suboxone therapies or strong, long-acting morphine or tamper-proof fentanyl patches as preferred alternatives for safe supply.

He warned young people are in danger of becoming the next generation of entrenched opioid users and called for the safe-supply program to be shut down.

But Henry said it’s vital to give people options and connection to the health-care system through programs like safe supply.

“It’s a very challenging situation, but we know we’re seeing the harms already on a daily basis for people who use drugs, so there are many, many competing things here that we need to do,” she said.

Henry said while she’s heard from people concerned about more drugs on the street, she’s also hearing from others that “they don’t want this program to disappear.”

“So those are all things that I’m working on and my report to government will be very soon,” she said.

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