A Canadian think tank says BC’s safe supply drug protocols protocols abandon accountability and evidence and seriously undermine recovery-oriented care.In a new report titled Reckless: British Columbia’s “safe supply” fentanyl tablet experiment, Adam Zivo reviews the newest drug protocols in BC and documents the evolution of Canadian safe supply opioid programs since 2020. Zivo reports a “concerning” lack of evidence behind the protocols and says they undermine recovery, drive diversion to the black market and ruin the lives of young Canadians.The new protocols not only avoid any requirement for drug users to first try evidence-based recovery programs before receiving high-potency opioids, but also allow minors to receive them, with no reference to the rights and roles of parents or even a minimum age for safer supply clients.Zivo also expressed deep concern over the BC government’s approach of continually increasing access to safe opioids despite openly admitting there is no evidence of proven benefits or safety.The protocols even require clients be told their access to free fentanyl and sufentanil will almost certainly be cut off if they are hospitalized or if they attend withdrawal management or substance treatment facilities.“The prospect of free fentanyl and sufentanil creates powerful incentives to sign away one’s rights to evidence based treatment, so the province is essentially exploiting clients’ addictions so that it can experiment on them without taking legal responsibility for potential harms,” Zivo explains.“One can reasonably expect that a significant portion of the fentanyl tablets being distributed by the BC government will end up being traded or resold on the black market.”Zivo adds mass diversion is already a major issue for weaker safer supply opioids such as hydromorphone.While addiction experts have been overwhelmingly critical of unsupervised safer supply, Zivo notes others believe the program has potential if it is reformed to provide more responsibly. By receiving safer supply as a temporary intervention, addicted users could transition to recovery-oriented treatments such as opioid agonist therapy (OAT.)“It would not take much to reshape BC’s safer supply of fentanyl and sufentanil programs into something more responsible and genuinely safe,” concludes Zivo. “There is nothing preventing the province from redesigning safer supply as a recovery-oriented intervention.”Correspondence by Zivo established that the BC Ministry of Health asked the British Columbia Centre on Substance Use (BCCSU) to create the protocols for safe supply. The BCCSU was created by former HIV/AIDS researchers.The protocols advise that “a single incidence of diversion is not a reason for discharging a participant from the fentanyl tablet program.”The BCCSU’s recommended response to repeat diversion is to “reassess and explore alternative options” in collaboration with the client, via “shared decision-making.” Zivo believes this approach is too lenient.“In other words, if a client habitually sells their safer supply fentanyl on the street, doctors are supposed to work with the seller to collaboratively decide what should be done, even though the seller has little incentive to propose a solution that interrupts their profits,” Zivo wrote.“Apparently repeat diversion should not be treated as a criminal issue because it only indicates that a client’s needs are not being met.”
A Canadian think tank says BC’s safe supply drug protocols protocols abandon accountability and evidence and seriously undermine recovery-oriented care.In a new report titled Reckless: British Columbia’s “safe supply” fentanyl tablet experiment, Adam Zivo reviews the newest drug protocols in BC and documents the evolution of Canadian safe supply opioid programs since 2020. Zivo reports a “concerning” lack of evidence behind the protocols and says they undermine recovery, drive diversion to the black market and ruin the lives of young Canadians.The new protocols not only avoid any requirement for drug users to first try evidence-based recovery programs before receiving high-potency opioids, but also allow minors to receive them, with no reference to the rights and roles of parents or even a minimum age for safer supply clients.Zivo also expressed deep concern over the BC government’s approach of continually increasing access to safe opioids despite openly admitting there is no evidence of proven benefits or safety.The protocols even require clients be told their access to free fentanyl and sufentanil will almost certainly be cut off if they are hospitalized or if they attend withdrawal management or substance treatment facilities.“The prospect of free fentanyl and sufentanil creates powerful incentives to sign away one’s rights to evidence based treatment, so the province is essentially exploiting clients’ addictions so that it can experiment on them without taking legal responsibility for potential harms,” Zivo explains.“One can reasonably expect that a significant portion of the fentanyl tablets being distributed by the BC government will end up being traded or resold on the black market.”Zivo adds mass diversion is already a major issue for weaker safer supply opioids such as hydromorphone.While addiction experts have been overwhelmingly critical of unsupervised safer supply, Zivo notes others believe the program has potential if it is reformed to provide more responsibly. By receiving safer supply as a temporary intervention, addicted users could transition to recovery-oriented treatments such as opioid agonist therapy (OAT.)“It would not take much to reshape BC’s safer supply of fentanyl and sufentanil programs into something more responsible and genuinely safe,” concludes Zivo. “There is nothing preventing the province from redesigning safer supply as a recovery-oriented intervention.”Correspondence by Zivo established that the BC Ministry of Health asked the British Columbia Centre on Substance Use (BCCSU) to create the protocols for safe supply. The BCCSU was created by former HIV/AIDS researchers.The protocols advise that “a single incidence of diversion is not a reason for discharging a participant from the fentanyl tablet program.”The BCCSU’s recommended response to repeat diversion is to “reassess and explore alternative options” in collaboration with the client, via “shared decision-making.” Zivo believes this approach is too lenient.“In other words, if a client habitually sells their safer supply fentanyl on the street, doctors are supposed to work with the seller to collaboratively decide what should be done, even though the seller has little incentive to propose a solution that interrupts their profits,” Zivo wrote.“Apparently repeat diversion should not be treated as a criminal issue because it only indicates that a client’s needs are not being met.”
