Understanding Safe(r) Supply

This week is all about the nuances of safe and safer supply, exploring the potential for these policy models to combat the toxic drug crisis and save lives.

Safe supply - what is it?

Safe supply, a term coined by People Who Use Drugs (PWUDs), refers to a regulated substitution for drugs sourced from illegal markets. It prioritizes legality, decriminalization, and non-toxicity, aiming to address the challenges associated with illicit drug use. In an ideal scenario, safe supply should be easily accessible, available in various forms (e.g., injection, smoking), and cater to the diverse reasons behind drug use.

Key features of a comprehensive safe supply approach include:

• Accessibility and Variety: Easy access in different forms to address individual preferences.

• Comprehensive Response: Tailored to the multifaceted reasons behind drug use.

• Potency without Lethality: Similar strength to illegal drugs but without lethal toxicity.

• Inclusive Choices: Offering alternatives like fentanyl, heroin, ketamine, cocaine, etc., without prescription barriers.

• Distinct from Opioid Agonist Therapy (OAT): Not to be confused with existing therapeutic approaches.

Is safe supply just another model of harm reduction?

Sort of. Safe supply aligns with harm reduction in mitigating the harms associated with illicit drug use within a prohibition-based system (i.e., the War on Drugs). It removes stigma through a morally neutral framework, treating PWUDs without prejudice. Viewed as a fully realized harm reduction model, safe supply ensures access to a secure, regulated drug supply, akin to the controlled availability of substances like Tobacco and Alcohol today.

Why is safe supply important today?

The current public health crisis underscores the urgency of safe supply. Unregulated, toxic street drugs have led to an alarming rise in deaths among PWUDs, making illicit drug toxicity the second leading cause of death in British Columbia. In 2023, 2511 lives were lost in BC alone. Safe supply addresses the root cause by eliminating poisonous unregulated drugs.

Although safe supply is not yet implemented nationwide in Canada, British Columbia has seen promising smaller-scale initiatives like safer-supply programs, Heroin Compassion Clubs, and advocacy-based giveaway models. Today, we'll delve into BC’s safer supply program as a crucial step toward combatting the overdose crisis.

Safer Supply in British Columbia

Safer supply should not be equated with safe supply. The former, a medicalized program, focuses on enabling People Who Use Drugs (PWUDs) to access pharmaceutical-grade medications through prescriptions. This distinction is important - safer supply is not synonymous with a fully comprehensive safe supply model.

In July 2021, the BC Ministry of Mental Health and Addictions unveiled a new program to address the drug poisoning crisis. The program aims to enhance access to prescribed safer supply (PSS), offering pharmaceutical alternatives such as Dilaudid (hydromorphone) to address issues related to heroin and fentanyl. However, the implementation faces challenges, with only 4% of individuals with Opioid Use Disorder (OUD) in BC able to access PSS, leaving a significant coverage gap.

A December 2023 review from the Office of the Provincial Health Officer emphasized the following key findings from the PSS program:

• Lifesaving Impact: Prescribed alternatives contribute to saving lives and reducing harm.

• Need for Further Evidence: There is a requirement for additional evidence, including monitoring and reporting mechanisms.

• Limited Scope: The prescribed safer supply is constrained and necessitates a broader spectrum of options, including fentanyl and medical-grade heroin (diacetylmorphine).

Despite the success of pilot studies and programs around the country, the concept of safer supply has become politically charged. Some Conservatives argue that these medications may be "distributed" or "diverted" to children. While there is a minimal risk of diversion, where prescribed drugs like hydromorphone may be pocketed and then sold or given away on the street, experts and advocates argue that this is not a significant problem.

Addressing misinformation as shown in the above Tweet is crucial, especially when safer supply is an evidence-based model with the potential to prevent the 22 Canadians who die every day from opioid toxicity. The focus should be on informed discussions, acknowledging the success of other programs and the positive impact safer supply can have on saving lives and mitigating harm.

That’s it for this week’s newsletter!

👋 Mel, Policy on Drugs

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