B.C. moves to 'safe supply' as overdose deaths spike during COVID-19 pandemic

Melissa Steinhauer remembers the first time she overdosed, waking up surrounded by paramedics and not wanting to be taken to hospital. 

"It was a huge scare for me when I woke up after getting naloxoned," she said, referring to the medication naloxone used to reverse opioid overdoses. 

"It's almost surreal and it's like a really bad dream."

Her overdose happened shortly after her older brother died from an overdose in the bathroom of a single room occupancy hotel in the Downtown Eastside of Vancouver. 

"It was fentanyl," she said. 

"It was that one piece that he got that was tainted, which is why we lost him."

The loss of her brother and her own overdose experiences led her to reflect on her work with the Western Aboriginal Harm Reduction Society (WAHRS), where she is board secretary, and what it means to apply those principles to her own substance use. 

Just a few weeks ago her options expanded and she was able to get on the new "safe supply" program introduced in response to the COVID-19 pandemic. She now has access to a wider range of prescription opioids in her treatment plan instead of buying them off the street where "you don't know what's in there."

"Safe supply — I know what's in it. I know that it's safe and there's nothing in there that's going to hurt me or that's harmful to me."

Now people like Steinhauer are hoping the program isn't just a temporary measure.  

The new guidelines were announced in late March in response to the COVID-19 pandemic — concerns about the drug supply becoming even further adulterated because of disrupted global supply chains and about people being able to access their treatment while in self-isolation. 

"It will ensure that less people turn to the poisoned drug supply and it will ensure that less people have to venture out to pharmacies regularly and still put themselves at risk and put the community at risk," said B.C.'s Minister of Mental Health and Addictions Judy Darcy in late March. 

Timing of safe supply 'bittersweet,' says advocate

B.C. declared a public health emergency in response to the overdose crisis four years ago. In the past four years, more than 5,000 people have died from an illicit drug overdose in B.C. 

Data from the B.C. Coroners Service shows that in March the province had its highest number of overdose deaths in a year: 113 people died from suspected illicit drug toxicity. 

But it took a second public health emergency — the COVID-19 pandemic — for the guidance on safe supply to be announced.  Between March and May 11, 130 people died from COVID-19. 

Tracey Draper, program co-ordinator with WAHRS, said it's "bittersweet" to have safe supply come online during the pandemic and she can't help but wonder "why it took COVID-19 to get safe supply." 

"It took two crises — two health crises — to get this to happen." 

Provincial data not yet available to show uptake 

The province wasn't able to provide data on how many people are benefiting from the new safe supply guidelines to date, but limited data from the Vancouver Coastal Health Region shows at least 300 people are now getting prescriptions that range from opiate therapies to pharmaceutical stimulant replacements. 

The new guidelines also capture people being treated for dependence on tobacco, benzodiazepines and alcohol. 

Dr. Nel Wieman, acting deputy chief medical officer with the First Nations Health Authority, said it will be important to monitor how successful patients are at getting access to safe supply across all health regions. 

"People typically have in their head this is the Downtown Eastside/urban issue," she said.

"The people living in rural and remote [communities] that have substance use disorders need access to safe supply as well."

The increase in telehealth services during COVID-19 gives Wieman hope that people in rural and remote areas are getting access to a wider range of providers and possibly providers who are comfortable with prescribing a safe supply. 

The safe supply eligibility criteria include:  

• People at risk of COVID-19 infection or who are suspected of being infected.

• People with a history of ongoing active substance use.

• People at high risk of withdrawal, overdose, craving or other harms related to drug use.

• Youth under the age of 19 who provide informed consent and receive additional education.

Opioid substitution therapies and other safe supply prescriptions aren't necessarily new in Canada, or B.C., but some of the prescriptions captured in the new guidelines have been difficult to access.  

That's because only a handful of physicians have been doing this kind of prescribing, according to Cheyenne Johnson, the co-interim director of the B.C. Centre for Substance Use. 

She said the COVID-19 pandemic created a new kind of political will regarding the overdose crisis. 

"There was nothing that was legally prohibiting physicians from doing this before the guidance," she said. 

The new guidelines are helpful, she said, with increasing the number of health care providers who are comfortable with this kind of off-label prescribing of controlled drugs. It also ensures they know "how to do this, what to dose, what to consider, what to document, how to have that conversation with your patient." 

Since the new guidelines were announced, the centre has been holding webinars for prescribers and pharmacies across the province. She said her team is engaged with stakeholders about the future of the guidelines, but there's no guarantee they're here to stay. 

Safe supply can be a pathway to recovery 

Johnson said research shows these programs can be effective at stabilizing people over time, reducing their exposure to street drugs and the activities many people rely on to pay for those substances like sex work and property crime. 

"And then as people become stable they become motivated… It can be a pathway into addiction treatment and recovery."

Melissa Steinhauer said knowing that she has access to a daily dose of oral morphine and hydromorphone gives her a new sense of stability and means not having to worry every day where she's going to get her supply. 

"It makes a huge difference," she said. 

She's been on oral morphine and suboxone in the past but the change to the safe supply guidelines mean she's been able to get a prescription for hydromorphone for the first time. That prescription also allows her to have "carries," meaning the pharmacy will give her a supply to take home and "carry" her through the day. 

She said this has eliminated her reliance on street drugs. 

"I don't have that worry that I have to go run out and buy off somebody off the street."