Michelle Gamage
Local Journalism Initiative Reporter
The Tyee
B.C. is restricting its safer supply program so that all patients have to be witnessed by a pharmacist while they consume their medication.
Safer supply is a program that works to separate people at highest risk of overdose and death from the unregulated toxic street supply of drugs by prescribing them pharmaceutical alternatives for the drugs they use. While this can include prescriptions for stimulants or benzodiazepines, the majority of prescriptions are for oral hydromorphone tablets, sold under the brand name Dilaudid.
About 3,900 people in B.C. are currently being prescribed safer supply, down from 5,200 at the program’s peak in March 2023. Since 2023, hydromorphone prescriptions through safer supply have decreased by 34 per cent, according to a press release from the Health Ministry.
Safer supply makes up only three per cent of all opioids prescribed in B.C., the ministry said. Most other prescriptions are for pain.
Safer supply differs from opioid agonist treatment, or OAT, in which people with opioid use disorder are prescribed Suboxone (a mix of buprenorphine and naloxone), methadone and/or slow-release oral morphine. OAT treats opioid use disorder by giving people longer-lasting drugs that don’t provide a euphoric rush but do prevent people from experiencing withdrawal.
On Wednesday the Ministry of Health said it was restricting its safer supply program so that new patients would immediately be required to take all of their medication in front of a pharmacist.
Clinicians who have previously approved patients to take some medication home with them will have to “transition existing patients to witnessed consumption as soon as possible,” the ministry said in a statement.
“Basically this kills prescribed alternatives and I think that’s really dangerous,” said Amber Streukens, program co-ordinator for the Rural Empowered Drug Users Network. REDUN supports people with lived and living experience of substance use throughout the West Kootenays.
“In a rural context any limitations to access points are significant for folks in our communities who use substances,” Streukens told The Tyee.
“We have communities in the Kootenays where you can’t get a bus to an urban centre more than three days a week. I live a 45-minute drive and a cable ferry out of town. There’s no bus here,” Streukens said. “If a person didn’t have a vehicle it would take them all day to get to the pharmacy once.”
Most safer supply prescriptions — other than the fentanyl patch — are for short-acting medications, Streukens said, so requiring a pharmacist to witness all doses means people will have to come to a pharmacy four to five times per day.
“People will drop off the program because it’s absolutely impractical to set up camp outside of your pharmacy,” she said.
The BC Greens also criticized the move.
“For people trying to maintain employment, care for their families or simply live their lives, the requirement to visit a pharmacy multiple times a day is untenable,” said Jeremy Valeriote, interim leader of the party, in a statement.
“This change risks pushing individuals back to the illicit supply chain, increasing overdose risks and worsening the crisis the BC NDP is trying to address,” the statement continued.
Concerns about diversion
Wednesday’s move by the Health Ministry appears to be in response to a leaked document contending that a “significant portion” of safer supply is being diverted and trafficked across B.C. and Canada and around the world. B.C. is investigating this diversion, according to the document.
The Health Ministry confirmed to CBC that the document was authentic and that the government was investigating diversion.
The Health Ministry told The Tyee Wednesday’s changes to the safer supply program were not in response to the leaked document.
“For months the public service had been developing options to address diversion as a result of new information coming to light from the investigation that was underway,” Minister of Health Josie Osborne told The Tyee in an emailed statement. Her mandate letter asked her to create “additional safeguards on prescribed alternatives and a comprehensive strategy on dealing with over-prescribing of opioids,” she added.
“Following the leak, there was a recognized need to update the public as soon as possible on the status of pharmacies under investigation and the steps being taken to curb diversion,” Osborne said.
Advocates point out that it’s unclear what role safer supply programs, which account for just a fraction of prescription opioids, play in diversion.
Advocates also say that responding to concerns about diversion by cracking down on safer supply will only be more harmful in the long run.
If safer supply drugs are being diverted, then that’s a sign the program needs to be tweaked, says Guy Felicella, a harm reduction and recovery advocate.
If a patient is selling their prescribed medication to seek out something more potent, a doctor needs to work with that patient to prescribe them medication that works better for them, Felicella said.
Felicella also pointed out that the political and media attention given to safer supply distracts from the cause of the overdose crisis, which is the “poisoned drug supply.”
“We’re talking about safer supply or prescribed alternatives more than the drug that is actually killing people, which is fentanyl,” Felicella said. “If the pill got into the wrong hands, you have to ask yourself, if they got that instead of getting fentanyl, well, at least they’re not dead.”
Unregulated street drugs are the leading cause of death in B.C. for people aged 10 to 59 because of the potency and unpredictability of the supply. Several drugs may be sold as one, with some substances 10,000 times more potent than others. Because of this, referring to the unregulated supply as “poisoned” or “toxic” is now common.
Fentanyl was detected in 83 per cent of all 2,253 unregulated drug deaths in 2024, according to the BC Coroners Service.
“Nobody just wakes up and starts doing Dilaudid,” Felicella said. “If someone has a rolling addiction that’s been going on for years, they can progress up to opioids, whether it’s heroin or prescription pills or fentanyl, eventually.”
Anyone claiming that safer supply causes addiction is spreading misinformation, he added.
“The worst thing you could do for someone’s recovery journey is make them go backwards,” he said.
Pharmacy crackdowns
The Health Ministry said it also planned to crack down on pharmacies that have been offering incentives to attract patients, which has been forbidden since 2016, or misusing fee-for-service payments, and to change the dispensing fee structure in a way that reduces “financial incentive for bad actors.”
There are a handful of pharmacies that have been “really shady,” Felicella said, adding that he doesn’t mind if the government moves to shut down pharmacies that have been taking advantage of people who use drugs.
“There’s the people who are just really in it for profit, right?” he said.
The ministry also said on Wednesday that the province will be working with the College of Physicians and Surgeons of BC and the BC College of Nurses and Midwives to “reduce the over-prescribing of opioids generally.”
That concerned Felicella, who warned that people living with chronic pain who are reliant on opioids to improve their quality of life and to live normally will be pushed to the unregulated market if their medications are restricted.
“There’s no doubt in my mind of that,” he said. “If we take away what helps them get through the day, they will turn to the unregulated market.”
Streukens pointed out that this was not the first time the government had stepped back from a program that was helping people who used drugs.
Northern Health was previously running a program that let peers deliver safer supply medications to people in rural or remote areas and it was “wildly” successful, Streukens said. She added she knows at least one person who has died as a result of the ending of the program.
“It feels like moral panic,” Streukens said. “There’s this stigmatizing focus on people who use drugs as if they’re inherently untrustworthy. Stigma fuels isolation and harm, and I worry when we build stigma into policy, it will not reduce harm.”
