B.C.'s safer supply program needs more choice, say drug users and advocates

Watchmen (not her real name) visits her pharmacist each day as part of B.C.'s safer supply program to pick up 14 pills of hydromorphone.

The pills are supposed to ease withdrawal symptoms and keep her away from the often-deadly illicit street drug supply. 

And while the hydromorphone works for some people who use drugs, it doesn't work for Watchmen.

What she really wants and needs is fentanyl. 

So what Watchmen does most often is take the hydromorphone pills and sell them for about $20. She then buys fentanyl on the street. 

With six people dying on average every day in the opioid crisis and B.C. on track to record more than 2,000 deaths this year alone, this is the very scenario that the safer supply program is designed to avoid. 

But despite the program's good intentions, a lack of choice is pushing some people back toward the dangerous street supply. 

"We take the money and just buy fentanyl straight off the block," said Watchmen, whose identity CBC agreed to conceal with a chosen pseudonym. "The fentanyl is just a better high. It's what we do. We're addicts, right? We want what we want."

And even though she is often quick to sell her hydromorphone, Watchmen is acutely aware of the dangers that come with the black market. 

"It can be extremely dangerous, not only from the amount that you're taking, [but] because you never really know what's in it unless you go and get it tested, which a lot of people don't do," she said. "The people that you have to deal with in order to get it can also be very dangerous. So you just have to really be on your toes."

Andrew Drury, an advocate for people on bail and probation on Vancouver's Downtown Eastside, says many of his clients sell their safer supply prescriptions for the drugs they want. 

"They get the pills and go to a certain area ... where you can very easily sell a whole jar of pills for around 20 bucks," he said. "The fix for all of this is to have free, prescribed, clean fentanyl, either for injection or with the patch."

Prevalence of prescription opioid diversion

The technical name for being prescribed a drug and not taking it is diversion. Geoff Bardwell, a research scientist with the B.C. Centre on Substance Use, has been studying that practice and recently published a report on his findings. 

Bardwell interviewed dozens of people and found the reasons for diversion include selling the prescribed drugs to pay bills, supplying loved ones with drugs that are known to be safe and, as with Watchmen, selling to buy different drugs.

"Hydromorphone is a really promising drug for people who want it. But then there's lots of people who might not want it and they might want something else," he said. "One of the recommendations from our study was if safe supply is going to be scaled up, we need to consider what types of models are being implemented. And arguably, there needs to be a range of drugs available for people."

Response from provincial government

Minister of Mental Health and Addictions Sheila Malcolmson declined a request for an interview, but the ministry said in a statement it will be announcing a new policy on safer supply in the coming weeks. 

"When we set out to expand this policy, we knew it would be highly complex work with varying perspectives about the right approach," the statement said. "We are continuing to work with the medical community to ensure prescribers and programs have the tools they need to prescribe a range of medications safely and with confidence, while also prioritizing patients' safety every step of the way.

"Prescribed safer supply requires considerable change for B.C.'s health care system — both operationally and culturally. Substance use is a health condition — not a moral one — and must be treated as such."

The government says 3,899 people were enrolled in the safer supply program as of May 2021. 

Watchmen and other people who use drugs will be watching closely for B.C.'s promised new policy.

She's clear that safe supply is in high demand, but from her perspective, it needs to provide what people want and need.

"People do want it. It's out there. There's a lot of need for drug replacement therapy, and I just hope that it can happen sometime," she said about the idea of safe fentanyl.

"It would be amazing, honestly. Like, still again, I don't think that anybody is really at that point yet, but it would just be a whole other step, like people can access what they need freely and not have to worry about getting hurt."