The rise in deaths due to street drugs with highly toxic illicit fentanyl is a public health crisis that has affected thousands of families and communities across Canada. The dramatic increase in numbers since the beginning of COVID-19 demonstrates a need to explore new approaches and clinical innovations such as safer supply to care for those with substance use disorders (SUD).
Safer supply refers to the prescribing of drugs such as opioids, stimulants and benzodiazepines as a safer alternative to the toxic illegal drug supply to people who are at high-risk of overdose. Unlike opioid agonist treatment, safer supply does not focus on stopping drug use but rather provides drugs to people with SUD in a safe and controlled environment where other health supports and services are available.¹
The College was pleased when the BC Ministry of Mental Health and Addictions, and the BC Ministry of Health released their policy direction paper last July, Access to Prescribed Safer Supply in British Columbia: Policy Direction, which called for augments to existing and established harm reduction strategies, including take-home naloxone, overdose prevention services, acute overdose risk case management, and treatment and recovery. The solution to the overdose crisis is multi-faceted and the government’s willingness to support safer supply programs and improve access to community services as a step forward is commendable.
The College’s role as a partner in the health-care system is often misunderstood as it relates to safer supply. Media has erroneously criticized the College for being a barrier to access, and implied that registrants fear that they will be audited or punished in some way if they administer safer supply to patients. This is simply not the case. The College does not prevent registrants from providing safer supply if it falls within their scope of practice and they have the appropriate training and expertise.
The College acknowledges that providing pharmaceutical-grade alternatives to the toxic street supply, both in the context of a comprehensive treatment plan or as a standalone harm reduction strategy, may allow registrants to better support patients with SUD, and may reduce their risk of overdose and death. With appropriate safeguards in place, including practising within the limits of their clinical competence and preferably in a team-based setting, registrants are encouraged to use their professional judgement to determine the best treatment plan for their patients.
Prescribing is complex, and even the most seasoned practitioners find prescribing of certain types of drugs challenging. As this issue becomes more and more acute, continuing professional development in this area is essential. All registrants, regardless of discipline, are encouraged to learn as much as they can about the management of SUD, including recognizing the signs, identifying those who may be at risk of overdose, and making referrals to specialists as necessary. Identifying and managing substance use disorder within one’s scope of practice is a core competency of all registrants.
The College’s role is to ensure registrants provide safe care to their patients. It has no role in advocating for or endorsing any particular clinical intervention or settling the scientific debate on the risks and benefits of safer supply. The College defers to experts in this field who are working together to gather more evidence to inform clinical guidelines and program developments.
Registrants who are interested in learning more about SUD and safer supply can engage with their health authority or the BC Centre for Substance Use to find out which programs and training are available in their jurisdiction.
Note: New Procedures for Harm Reduction Prescriptions
The BC Ministry of Health is asking prescribers and pharmacists to add “SA” (safer alternative) to prescriptions and PharmaNet entries for prescribed harm reduction drugs to improve data for safer supply programs and identify unintended risks or harms. The College urges registrants to adhere to this request.
Footnote:
1. Government of Canada, Safer Supply
