Interior Health's slow progress on safe supply frustrates doctor, advocates

UPDATE — Sept. 8, 2022: In a statement on Sept. 7, Interior Health said they would be working with Dr. Michael Vance to "dedicate additional nursing time to support a safe supply service for Nelson and area."

"We appreciate Dr. Vance's commitment to these vulnerable individuals and will be working with him in the weeks ahead to get the service implemented as quickly as possible," a spokesperson said.

A doctor in Nelson, B.C., says after four years of trying to establish a safe supply program through conversations with the local health authority, he is making his frustrations public with hopes it will pressure officials into action. 

Dr. Michael Vance, a family physician who focuses on addictions, says he's had multiple meetings about safe supply with Interior Health over the span of four years.

However, the health authority has never committed to providing him with the funding for a nurse, which would allow Vance to adhere to professional recommendations around prescribing safe supply in a team-based setting. 

Vance would like to be able to prescribe drugs such as fentanyl, sufentanil, and morphine, which are allowed under B.C.'s safe supply program. He says the prescribed drugs would help people get off an increasingly toxic street supply, which has already resulted in a number of fatal overdoses in Nelson and the West Kootenay region this year.

"How many more deaths need to happen before we actually put our money where our mouths are and get this treatment going?" he said.

"Every time I go to these meetings, I get more and more frustrated that there's people dying and we're not doing anything. I just can't understand how we can continue."

Vance said he's already able to prescribe drugs like hydromorphone without the aid of support staff, as part of programs that are in place across the province. These are also used for opioid agonist therapy (OAT), which provides opioid users with longer-acting drugs to reduce dependency.

However, the B.C. College of Physicians and Surgeons says doctors looking to prescribe safe supply drugs should do so "preferably in a team-based setting," and there should be safeguards in place. Vance says prescribed safe supply programs are set up with multidisciplinary teams to ensure smoother administration.

The health authority confirmed in an email that there are no safe supply programs they are aware of in Nelson. Health authorities are responsible for dispensing funding for safe supply programs. 

"Interior Health has implemented, or is in the process of implementing, services that offer prescribed safer supply in Kelowna, Vernon, Kamloops and Penticton," a spokesperson said. "Planning for other communities is underway."

Safe supply not reaching rural communities

Vance said dozens of his clients would benefit from a prescribed safe supply, and that they aren't able to travel to Vancouver or the province's bigger urban centres to do so.

He says the lack of funding for safe supply in rural areas of B.C. is negatively impacting drug users there, with some communities seeing extremely high rates of death.

Holly Trider, a peer worker with Kootenay-based harm reduction organization ANKORS, says it is "hard not to feel abandoned" by Interior Health's slow progress on the issue.

"Living rurally adds an extra barrier to how safe supply rolls out here. Many folks live an hour or more from their OAT clinic, relying on a public transit system that, well, isn't reliable," she said. "If they cannot get at least weekly [prescriptions], then safe supply just isn't feasible for them."

In addition, Trider criticized hydromorphone and other drugs used for OAT as not being close enough to the drugs people are using daily.

"Safe supply does not work if it's done halfway like this. So yes, this means fentanyl and proper stimulants' availability," she said. "It is my understanding that we do not have these options for our folks because there is no one to run the program.

"It is devastating and infuriating to see all this loss, pain and struggle — when we know the answer, and our health authority holds the power to make it happen."

Compassion clubs another option

Dylan Griffith, the founder of the Kootenay Insurrection for Safe Supply, says prescribed safe supply programs are beneficial for drug users because they get connected to health care as a result, and it offers stability.

However, he says that in the context of a primary health-care crisis and stigma against drug users on the part of some doctors, the prescriber model alone would not be enough to solve the toxic drug emergency.

Griffith is advocating for a compassion club model in the Kootenays, which sees drug user groups hand out tested drugs at cost to participants in a program.

"We're sick of watching our friends and neighbours die," he told CBC News. "If [the government] is not going to implement those solutions then we will."

Griffith said he is aware of four people who died of a fatal overdose in Nelson over the past three weeks, and he would be working with drug user groups to get his program off the ground.

"For some people, those substances are necessary for them to function in daily life," he said. "We believe that denying them access to a clean supply of those drugs is a violation of their rights."