Visions Journal

Challenging fear with facts

Nancy Henderson

Reprinted from the Families, Friends and Substance Use issue of Visions Journal, 2024, 19 (2), pp.16-18

More than 13,000 people have died in BC since 2016, when the province declared the drug toxicity (overdose) crisis a public health emergency.¹ The number of people dying continues to rise, with devastating effects on individuals, families, friends and entire communities.

The main cause of these deaths is the unregulated and contaminated drug supply. Without quality control, people do not know what is in the street drugs they buy. Street drugs are commonly “cut” with additional substances to make the drugs go further and enhance their effects. The additional substances are unexpected and sometimes more potent than the drug itself, making the street supply unpredictable and toxic.

Facing more drug toxicity deaths and given COVID-19 pandemic social distancing orders, BC became the first and only province to offer prescribed safer supply.² That means prescribers can provide people who use drugs with a combination of medications, including hydromorphone (Dilaudid) and methylphenidate (Ritalin) tablets. People are typically required to pick up their medications daily at a pharmacy. A limited number of programs also offer injectable medications, like diacetylmorphine, that people consume at a clinic.² In addition, federally funded prescribed safer supply programs are operating in BC and elsewhere.

Still, misinformation and fear-based ideas about prescribed safer supply have spread through society. Right-wing media sources repeat these ideas, taking the focus away from solutions. We need tools to inform the public and encourage evidence-based conversations. In this article, I introduce some facts about prescribed safer supply that you might hear about less often in the media.

Drugs and youth

The leading cause of death among BC youth aged 10–25 is drug toxicity, which has overtaken both accidents and suicide.³ Yet evidence tells us that rates of new opioid use disorder diagnoses among youth have not increased since March 2020.⁴ Youth are exposed to the same unpredictable and toxic street supply of drugs as adults. This is causing the increase in drug toxicity deaths, not hydromorphone tablets. As we hear every month from BC’s Chief Coroner Lisa Lapointe, there is no evidence that prescribed safer supply is contributing to drug toxicity deaths.³

Deprescribing

As of March 2023, 5,044 people in BC were receiving safer supply prescriptions;⁵ four months later, in July 2023, that number was down 11% to 4,476.² This decrease raises a red flag related to deprescribing opioids, meaning the loss, by an individual, of their prescription for opioids. When this happens, a person is forced to access the street supply of drugs to replace lost medications.

Evidence shows opioid deprescribing can increase a person’s risk of suicide, uncontrolled pain and drug toxicity death.^{6, 7} If the prescriber (a physician or nurse practitioner) decides to carry out this high-risk act, it needs to be done slowly and in collaboration with the patient.^6-8 The reasons for the current level of deprescribing are unclear. However, the timing of the decrease coincides with increased fear-based political and media attacks on safer supply prescribing.

Diversion

Diversion means sharing or selling medication with someone for whom it was not originally intended. We see diversion happen with all different kinds of people, all the time. My friend once told me their mother gave them half of their hydromorphone tablet so they could both relax after a long and difficult day. Neither of these adults is considered to be a person who uses drugs. Nor do they have opioid use disorder. They simply knew they would find relief from the tablet originally prescribed for the mother’s chronic pain. This is an example of compassionate care that happens with people in many communities, not just among people who use drugs.

Only 14% of all hydromorphone prescriptions in BC are going to safer supply participants.¹ The vast majority are going to people who have chronic pain—totally unrelated to safer supply.¹ Think of all the people in your life with chronic illnesses or who have had surgery. There is a good chance they still have a bottle of hydromorphone tablets. Leftover tablets are often saved just in case, and they are just as likely as tablets from safer supply prescriptions to end up mixed into the street supply of drugs.

Returning to people accessing prescribed safer supply, medication sharing and selling tells us not all people who use drugs can access the medications they need, and people who use drugs are required to help individuals in their community because the government is failing to do so. In the context of the drug toxicity crisis, political and media attacks directed at prescribed safer supply are more about fear and hate than diversion. The resulting stigma and shame pushes people who use drugs further away from the services and treatment they need.

Prohibition and the war on drugs

The drug toxicity crisis is being fuelled by the war on drugs, which is, in fact, a war on people who use drugs. There cannot be a war against a thing—war is always directed at people. Prohibition, or laws that make drugs illegal, is the reason why we have a street supply of drugs that is not regulated by the government.

Because of the war on drugs, people who use drugs are stigmatized. This creates fear of the other within communities. The resulting messaging based on stigma and fear then leads to moral panic (widespread fear of threats to community values). When talking about the drug toxicity crisis, we need to understand that prohibition, the war on drugs, stigma and moral panic are interconnected. We must remember that people who use drugs often face social and structural inequities, such as extreme poverty and systemic racism. These inequities contribute to the criminalization of people who use drugs and to poor health outcomes.

By offering safer supply, the federal and provincial governments are acknowledging that unregulated drugs are toxic and causing people to die. However, that acknowledgment is lost when people who need access cannot get a prescription.

Community-led responses

We need conversations about why people use drugs in the first place. People use drugs to get a benefit—to stay awake, belong, attend to trauma, feel better, manage pain, feel pleasure, etc. People, including youth, do not simply use drugs because they have access to them. There is usually a reason behind their use.

People who use drugs need to guide the direction of safer supply. Drug user groups have proven they are organized and capable. This has been shown through years of organizing community-led syringe distribution programs and overdose prevention sites since the 1980s. Policy limitations related to accessing and distributing drugs need to be lifted so drug user groups can lead and communities can heal.

People need to be able to obtain and use drugs without the threat of violence, criminalization and death. We need policy and legislative changes that include human rights, social justice and reparation for the harms done to communities. This starts with equitable access to a safer supply.

Safe Supply Facts

Prescribed safer supply means prescribing medications to replace toxic street drugs. Some facts about safer supply:

• The street supply of drugs is becoming increasingly unpredictable and toxic, leading to six drug toxicity deaths every day in BC.¹

• In March 2020, BC started offering prescribed safer supply to people who use drugs.²

• Approximately 100,000 people in BC have opioid use disorder.⁹ With only about 4,500 people currently receiving prescribed safer supply,² less than 5% of people who need safer supply are getting it.