Content warning: This article contains topics surrounding unregulated drug poisoning deaths. This may be difficult for some readers.
Researchers with the BC Centre for Disease Control (BCCDC) are working to better understand the implementation and outcomes of providing a regulated supply of drugs to people who are at risk of overdose.
August 31st marks International Overdose Awareness Day, an annual campaign to end overdose, reduce stigma, remember who have died and acknowledge the grief of their family and friends. For many who have been touched by the crisis, this year’s theme, “This is More Important Than Ever,” speaks to the urgency of calls to provide a safer supply of drugs to people who use substances.
Safer supply programs enable people to access regulated drugs, meaning pharmaceutical grade substances of known composition and potency, to reducing reliance on unregulated, toxic illicit drugs and thus decreasing the risk of overdose and death.
More than 10,000 people in B.C. have died from the toxic unregulated drug supply since a public health emergency was declared in 2016.
“The increasing toxicity of the unregulated supply is driving drug poisoning deaths,” said Dr. Alexis Crabtree, Public Health Physician, Substance Use and Harm Reduction with the Public Health Response team. “These are preventable deaths and safer supply is one intervention we can make available so people don’t have to rely on a poisoned supply.”
Treatment for problematic substance use works for some people while other people may use drugs throughout their lives. Others may stop using drugs for a period of time and then use them again. Many people who use drugs do not have a substance use disorder and therefore treatment is not indicated.
“When people need to use drugs, they shouldn’t have to risk their lives when we have regulated and safer substances,” said Dr. Crabtree.
Guidelines introduced by the BC Ministry of Mental Health and Addictions and the BC Centre on Substance Use in spring 2020 and summer 2021 enabled health care professionals to prescribe safer alternatives to people who use substances as part of efforts to manage dual public health emergencies of the toxic drug crisis and the COVID-19 pandemic. In 2021, the policy was decoupled from COVID-19 measures.
“The guidelines were introduced at a time of significant crisis to address the root cause: the unregulated drug supply,” said Dr. Amanda Slaunwhite, senior scientist with the BCCDC and assistant professor (partner) in the School of Population and Public Health at UBC, who is co-leading several projects examining the impact of the policy. “No other jurisdiction in North America has similar policies so we are in a unique position to measure the effect of prescribed safer supply on overdose.”
Slaunwhite collaborates with peer, academic and health organizations including the Centre for Health Evaluation and Outcome Sciences, Canadian Institute for Substance Use Research, First Nations Health Authority, BC/Yukon Association of Drug War Survivors, and others. People with lived and living experience from across BC are engaged in the project including the collection of data and interpretation of findings.
“Some people wonder if making regulated drugs available may lead to more drug use and an increase in overdose deaths,” said Slaunwhite.
“One of the most important findings so far has been showing that safer supply has not directly contributed to the increase in overdose deaths we have seen during the pandemic.”
For this work, Slaunwhite and her team routinely examine toxicology data from the BC Coroner’s Service and analyze linked administrative health data on prescribed safer supply that is available at the BCCDC. They found there were no illicit drug toxicity deaths where prescribed hydromorphone was detected alone and contamination of the illicit drug supply with fentanyl continues to be the leading cause of overdose death in the province.
More broadly, Slaunwhite and her team have worked to evaluate how prescribed safer supply has been implemented throughout B.C. and its impact. They’ve found that:
- People living in urban areas where there are more addiction specialists are more likely to access prescribed safer supply.
- Barriers to accessing prescribed safer supply in more rural and remote communities include having access to pharmacies where people can fill prescriptions and access to overdose prevention services.
- Preliminary data suggests there is emerging evidence that prescribed safer supply protects against all-cause mortality which researchers are investigating the reasons further.
“In an emergency situation, introducing measures to reduce deaths are essential but with evaluation embedded so we can continuously make adjustments and improve outcomes,” said Dr. Reka Gustafson, Vice President of Public Health and Wellness with the Provincial Health Services Authority.