B.C. to require addicts to take opioids before a medical witness

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British Columbia is revising its rules around the safer supply of opioids, mandating that the consumption of prescribed drugs must be done under the supervision of a medical professional.

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Health Minister Josie Osborne said the “significant” change to end the take-home model will be difficult for some, but is designed to reduce the criminal diversion of prescribed alternatives to illicit street drugs.

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Osborne said health-care workers will watch the consumption of prescribed alternatives, including the opioid hydromorphone, with the change effective immediately.

In 2020, B.C. launched a province-wide safer-supply program, which allowed addicts at high risk of overdose from street drugs, such as fentanyl, to obtain pharmaceutical-grade alternatives.

Since then, the program has garnered significant controversy, particularly with regards to how prescribed drugs have been re-sold on the street, so that addicts could then purchase their street drug of choice.

“Prescribed alternatives have been proven to save lives by providing a safer option for people at high risk of overdose. We are requiring that the use of prescribed alternatives must be witnessed by a health professional. This will remove the risk of these medications from ending up in the hands of gangs and organized crime,” said Osborne in a Wednesday news release.

The requirement that consumption be witnessed will be implemented immediately for new patients. Existing patients receiving prescribed opioids will be transitioned “as soon as possible.”

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“These medications will be taken under the supervision of a health-care worker, and that includes hydromorphone,” she told a news briefing in Victoria on Wednesday.

“This helps guarantee that the patient receives care in a safe, supportive environment, and significantly reduces the likelihood of diversion.”

Prior to the changes, patients were able to take their prescribed drugs with them, after which point the health system had no way of knowing whether they were consumed by the patient, sold or used by another person.

A significant portion of the prescribed opioids being freely prescribed by doctors and pharmacists are not being consumed by their intended recipients

B.C. Ministry of Health document

Dr. Paxton Bach, a professor of medicine at the University of British Columbia and co-director of the British Columbia Centre on Substance Use, said it’s important that public policy shifts as the evidence shifts.

“If there’s evidence out there that the harms of a public-health policy are potentially outweighing its benefits, then it’s important to adjust accordingly,” Bach said.

Critics of the safer-supply program have long complained that diversion of the prescribed drugs such as hydromorphone was being downplayed.

Osborne said an investigation into diversion was started by a Ministry of Health investigative unit last June.

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Two weeks ago, a B.C. ministry of health document was leaked that said opioids prescribed in B.C. were being diverted, and prescribed alternatives were being trafficked provincially, nationally and internationally. The document said some 22 million doses of prescribed medication have been distributed to 5,000 addicts in British Columbia. (Only about four per cent of the 150,000 British Columbians with substance-use disorders have accessed the prescribed opioids program.)

“A significant portion of the prescribed opioids being freely prescribed by doctors and pharmacists are not being consumed by their intended recipients,” the document states.

Research into safer supply programs, such as a June 2023 paper in the Harm Reduction Journal that reviewed safer supply programs in Ontario, has concluded that prescribed opioids have a variety of positive benefits, including reductions in overdose-related deaths and improved health and social outcomes. However, a January 2024 review of B.C.’s safer supply program found that its launch coincided with an increased number of drug-related hospitalizations and the number of people being prescribed opioids. There was no “statistically significant” increase in deaths during the program’s operation.

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The province is also investigating allegations that more than 60 pharmacies have misused the publicly funded payment structure to offer incentives to patients and doctors to have them prescribe the supply of opioids. The pay structure, the news release says, will be modified to “avoid financial incentive for bad actors to offer kickbacks to retain and attract new patients, and to try to take advantage of the system.”

“I want to emphasize that we have over 1,500 pharmacies in British Columbia, and most pharmacies are providing high-quality care to people, but through these investigations we’ve received allegations of this kind of illegal activity at roughly 60 pharmacies, and we are investigating every single one of them,” she said.

Osborne said the government would work closely with the College of Pharmacists of B.C., “and then if the information warrants being passed on to the RCMP for criminal investigation, we’ll pass that on there.”

Osborne said that the ministry investigators began their work after “allegations, stories, anecdotes came forward last year.”

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The number of British Columbians prescribed alternative opioids peaked at nearly 5,200 people in March 2023, and has since declined to less than 3,900 people as of December 2024, the B.C. government says.

Critics of the policy, including the opposition Conservatives, have claimed the program is keeping people dependant on opioids and that the drugs are being diverted to others, including minors.

The new program will present challenges for some users, Bach said. A similar pilot program in Vancouver, run pre-pandemic, also had drug users taking drugs under supervision.

“It was really difficult to retain people,” Bach said.

In order to access prescribed opioids, and then consume them under supervision, drug users would be limited by, for example, pharmacy or clinic hours. And opioid substitutes only last a couple hours, meaning some addicts would need to travel multiple times each day to obtain and use their medication.

“That’s a very significant ask from an individual who has a job, a family, dependents, hobbies. That becomes quite a high bar to set,” said Bach. “It will limit the number of people or who are able to access such programs, for better or for worse.”

With additional reporting by the The Canadian Press and Vancouver Sun

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