Nearly 10 years after BC’s provincial health officer declared a public health emergency due to opioid-related overdose deaths, deaths due to overdose are still occurring at alarming rates. Evidence indicates that Indigenous people are disproportionally affected by this crisis, dying at six times the rate of non-Indigenous BC residents.
One of the harm reduction measures implemented in BC to combat the toxic drug crisis is prescribed alternatives, also known as safer supply or safer alternatives. Prescribed alternatives refers to providing prescribed 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.
On February 19, 2025, the Province of BC announced changes to the prescribed alternatives policy, requiring that the use of prescribed alternatives must be witnessed by a health professional. These changes went into effect immediately for all new patients, while patients already being prescribed alternatives are to be transitioned to witnessed dosing.
The BC Centre on Substance Use (BCCSU) has developed an Interim Clinical Resource: Transition to Witnessed Dosing for Prescribed Alternatives to support the safe transition of existing clients from non-witnessed to witnessed doses. This interim clinical resource is to support registrants and patients while provincial policy amendments are being further developed. This replaces the guidance previously published by the BCCSU, including the Opioid Use Disorder Practice Update.
Note: This policy change does not apply to opioid agonist treatment (OAT), including take-home OAT doses.
CPSBC's role as it relates to prescribed alternatives is to ensure registrants provide safe care to their patients, not to endorse any particular clinical intervention or to settle the scientific debate on the risks and benefits. CPSBC defers to experts in this field, including the BCCSU, to gather evidence and to develop clinical guidelines and programs.
As always, registrants are encouraged to use their professional judgement to determine the best treatment for their patients, which may include providing pharmaceutical-grade alternatives to the toxic street supply. CPSBC does not prevent registrants from providing prescribed alternatives if it falls within their scope of practice and they have the appropriate training and expertise.
All registrants, regardless of specialty or discipline, are encouraged to learn as much as they can about the management of substance use disorder, 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.
Registrants who provide patients with prescribed alternatives are strongly encouraged to undertake extra training in the management of substance use. Resources and education are available through the BCCSU and the Provincial Opioid Addiction Treatment Support Program. Registrants are also reminded of the following requirements for prescribed alternatives:
- “SA” (safer alternative) must be written in the “Directions for Use” section of the duplicate (Controlled Prescription Program) prescription form. This step is essential as it enables the BC Government and partners such as the BCCSU to measure the effects of prescribed alternatives, modify treatment programs, and construct sound clinical practice guidelines.
- To assist pharmacists, directions for dispensing must be clear and concise. See the appendix of the Interim Clinical Resource: Transition to Witnessed Dosing for Prescribed Alternatives for samples of the Controlled Prescription Program form for prescribed alternatives.
- Prescribers must be available to pharmacists for any questions related to filling the prescription.
Resources for registrants