The number of people accessing safe supply in B.C. has dropped. It's unclear why — but it's prompting concerns

The number of people accessing a prescribed safe supply (PSS) of illicit drugs in B.C. has dropped by more than 11 per cent over four months according to the provincial government, although the reasons for the decrease are unclear.

More than 5,000 people were prescribed opioid, stimulant and benzodiazepine alternatives in March this year, according to data shared by the province. 

By July, that number was 4,476. The province says it is investigating the reasons behind the drop.

Those reasons are likely complicated, according to one doctor, who says the drop may be attributed to the labour-intensive nature of safe supply prescription. 

Some advocates are also expressing concern that drug users without prescriptions could be forced to turn to the illegal drug market. The contaminated drug supply has killed 1,455 people so far this year.

"The people that don't have high tolerances for unsafe supply — once they get cut off and go back to the street, their chances of overdose are really, really high," said David Keeler, a patient in the PSS program receiving oxycodone tablets daily to deal with opioid addiction, and a street ambassador for SOLID Outreach in Victoria.

PSS just one part of response: province

A spokesperson for the province says PSS aims to help people stabilize their lives, and is just one of the responses to the toxic drug crisis along with addiction treatment and early intervention.

"The number of people on PSS is determined by how many clients have been dispensed one of the drugs under PSS, in each month," they wrote in a statement.

"The province is examining the reasons for the drop in opioid PSS, which likely vary from case to case and are based on individual clinical discretion."

The B.C. Coroners' Service has found no evidence that prescribed safe supply has contributed to drug overdoses.

Criticisms over safe supply

Safe drug supply has also been the subject of criticism. Some researchers say more addiction treatment should be the preferred solution to the toxic drug crisis. Conservative leader Pierre Poilievre has claimed that government-funded safe supply is leading to people reselling drugs and dying on fentanyl-laced opioids.

Dr. Ryan Herriot, director of SAFER Victoria — which dispenses medications like fentanyl patches and tablets as part of a safe supply initiative — says access to the province's PSS program is largely dependent on the decisions of individual doctors, with the province providing guidance to help assess whether safe supply is right for their client.

Dr. Michael Vance, a Nelson, B.C.-based doctor who previously fought for the right to prescribe safe supply, says there is likely a range of reasons for the drop in the number of people on PSS.

One of them may be that certain doctors worry that opioid alternatives, like hydromorphone, may end up in the hands of youth or criminals.

"Different programs are moving away from hydromorphone to other safe supply options — such as fentanyl patches and fentanyl tablets," he said in an email to CBC News.

Vance has previously said that the dispensing of fentanyl patches and similar drugs often requires a team-based setting, along with safeguards and regular testing in place for patients.

"[This] may be more labour intensive, resource-heavy and thus [prescribers] can't handle as big of a patient load."

Vance added that, under the PSS program, some drug alternatives simply aren't doing the job for drug users, which may explain why some prescriptions are not being renewed.

Keeler says in his experience, drug users often have to top up their daily prescriptions of opioid alternatives.

"I can honestly tell you, that most of the people that are addicted to fentanyl … they could take their whole daily prescription all at once, and it wouldn't even touch their withdrawals," he said.

'Misperceptions' likely 'driving the de-prescribing': nurse

Corey Ranger, president of the Harm Reduction Nurses' Association, helps run the PSS program at AVI Health & Community Services, a Vancouver Island-based non-profit.

"The goal in prescribed safe supply is to stop deaths by the unregulated drug supply," Ranger said.

"These programs are being rigorously monitored and surveyed and evaluated … yet the myths and misperceptions, rhetoric and intentional politicizing of safe supply is causing a deep amount of harm and is likely driving the de-prescribing."

Herriot said it is never good when his work is debated on the floor of the House of Commons, and that he hopes "life-saving" prescribed safe supply would be protected against politicization, even expanded to include more options, including inhaled drugs. Poilievre recently attempted to pass a bill that called for the end of government-funded safe supply.

"I hope that the B.C. government finds the courage that it needs to defend and expand this," Herriot said, "no matter who's in power in Ottawa."