Earlier this month, Dr. Bonnie Henry, British Columbia’s provincial health officer, attempted to make her province even more of an outlier than it already was in its response to the unprecedented drug crisis. Recognizing that prior harm reduction interventions had failed to bend the curve of the drug crisis, she submitted a report that recommended that British Columbia “enable access to non-prescribed alternatives to unregulated drugs,” that is, encourage availability of an unadulterated supply of lethal drugs in retail stores, buyers’ clubs, and community centers.
Prior to this recommendation, British Columbia had arguably already adopted the world’s most laissez-faire drug policy, much to the opposition of its residents. Following an approach known as harm reduction, officials distributed naloxone, which can reverse opioid-induced overdoses, and sterile syringes, which can prevent the transmission of Hepatitis C and HIV. Yet those were not enough. Next came more extreme versions of harm reduction, such as supervised consumption sites, which enable drug use and make it appear safe because it occurs under the supervision of medical professionals. After those measures also failed to make a dent in the drug crisis, officials introduced prescribed alternatives, or “safer supply,” which provides an unadulterated, so-called “safe” supply of drugs to people with substance use disorder with a referral from a doctor.
Unsurprisingly, prescribed alternatives also failed. Though many other provinces—and countries—would recognize these failures and pivot to a different approach, such as one focused on prevention and treatment, British Columbia is doubling down on harm reduction. Prescribed alternatives, its officials argue, failed not because they are inherently flawed or at odds with recovery, but because they were not scaled up widely enough.
So here we are. Now, officials in British Columbia want to implement an unproven approach of non-prescribed alternatives, meaning people will not need a doctor’s prescription to access these lethal drugs. Dr. Henry suggests people ought to be able to walk into a store to buy heroin or fentanyl just as easily as they could get tobacco or alcohol. Yet we have seen the harmful result of increasing access to these latter two drugs—as use rises, so too does misuse. The report also mentioned that “some funding would likely be needed initially and perhaps ongoing,” indicating that taxpayers would likely be subsidizing heroin and fentanyl use.
One leading concern with non-prescribed-alternatives—and with prescribed alternatives, for that matter—is that they will increase diversion, finding their way into the hands of non-users such as minors. Reporting gives reason to believe this is already occurring. In practice, individuals are selling their prescribed alternatives to buy their favored street drugs. The report from British Columbia even conceded that “greater exposure of the population to diverted medications could result in increased rates of opioid use disorder,” adding that the “extent to which medications are being shared or sold is not known.” Any potential harm that is reduced by prescribed alternatives would almost certainly be outweighed by newfound harms caused by unintended consequences.
Recognizing the recklessness of this proposal, British Columbia’s minister of mental health and addictions, Jennifer Whiteside, said, “Dr. Henry is an important independent voice on public health issues in this province, and we respect her advice…. However, this is a topic we do not agree on.” Dr. Henry’s proposal was rejected. “Addiction,” Whiteside argued, “is a health issue and people struggling with addiction need access to the full continuum of services provided by our health care system.”
The organization I help lead, the Foundation for Drug Policy Solutions, echoes this message, as does the Policy Roundtable On Substance Prevention Education and Recovery, a new organization in British Columbia. The drug crisis requires a comprehensive approach premised on prevention, treatment, and recovery, as well as supply reduction. There is indeed a role for evidence-based harm reduction interventions, such as naloxone, but these should not represent the only or favored response to the drug crisis. We need to ask, “What happens after naloxone?”
The drug crisis will only be overcome by a reduction in demand for drugs—by discouraging use and helping users to stop—not by “enabling access” to them.
It is also important to note that people with opioid use disorder already have access to a supply of evidence-backed prescription drugs to assist with withdrawal symptoms, in an approach known as pharmacotherapy. Methadone, naltrexone, and buprenorphine are safe and effective prescription treatments for opioid use disorder. Medication-assisted treatment can allow people to thrive in recovery and regain a sense of control over their daily lives.
Policymakers should focus on proven types of treatment that encourage recovery, not so-called prescribed alternatives that encourage use. Even Dr. Henry’s report stated that nearly three times as many clinicians prescribed opioid agonist treatment, such as methadone, compared to prescribed alternatives, noting that “some clinicians have expressed concerns about prescribing alternatives.”
Though Dr. Henry’s proposal for non-prescribed alternatives was swiftly rejected, its recommendations are unlikely to disappear from public debates anytime soon. People must understand there is no single, stand-alone solution to the drug crisis, but the goal of drug policy should always be to make treatment and recovery more accessible than drugs. We must take a comprehensive approach that prioritizes prevention, evidence-based treatment, market disruption, and increases access to recovery services. Too many lives depend on it.
Read the entire article HERE.