Adam Zivo: B.C. winds down practice of sending addicts home with free drugs

British Columbia recently mandated that, starting from the end of this month, most “safer supply” drugs must be consumed under medical supervision in an effort to keep them from being diverted to the black market. While this reform is laudable and will help keep dangerous opioids off Canadian streets, it is reprehensible that the province dragged its feet for years here.

“Safer supply” refers to the experimental practice of prescribing addicts free recreational drugs — typically hydromorphone, a heroin-strength opioid — with minimal supervision under the assumption that this dissuades use of riskier street substances.

Although the BC NDP aggressively championed safer supply throughout the 2010s and 2020s, it eventually backpedalled after media reports showed that many recipients sell their free hydromorphone to purchase illicit street fentanyl, and that this floods communities with diverted opioids, fuelling addiction.

This course-correction was glacial and grudging, though. When the National Post, citing over a dozen addiction doctors across Canada, first reported on widespread safer supply diversion in mid-2023, the BC NDP insisted that the program was not contributing to addictions or deaths and that diverted hydromorphone seizures were not increasing.

Later that year, dozens of addiction doctors signed two public letters warning about safer supply diversion and begging for mandatory witnessed consumption. B.C.’s top doctor, Bonnie Henry, also produced a report which confirmed, through extensive consultation with the province’s doctors and addicts, that safer supply diversion is a “common occurrence.”

But these revelations had no discernible impact on B.C.’s drug policies.

Evidence of a diversion crisis only piled up in 2024: not only did the RCMP conduct several high-profile hydromorphone busts, the B.C. Association of Chiefs of Police told the House of Commons health committee that roughly half of the hydromorphone seized in the province could be attributed to safer supply.

Still, the province refused to implement anti-diversion measures.

The BC NDP only pivoted towards witnessed consumption in early 2025, after a leaked ministerial report confirmed that the province was secretly investigating safer supply diversion, and that “a significant portion” of safer supply opioids were being resold on the black market and trafficked “provincially, nationally and internationally.”

But when the province’s new interim safer supply prescribing guidelines were published in May, addiction experts were surprised by how toothless they were.

While the guidelines mandated witnessed consumption for all new safer supply patients, existing recipients could be kept on unwitnessed doses in “extraordinary circumstances” so long as their prescribing clinicians believed there was: a very low risk of diversion, a significant risk of patient destabilization if witnessed consumption were imposed, and “documented objective benefit from receiving unwitnessed doses.”

The document did not provide clear tests for determining how patients met these three conditions. For example, possible indicators of “objective benefit” included “improved health” and “social stability,” but these terms — among many others — were left vaguely defined and open to broad interpretation.

Doctors were advised to engage in “collaborative decision-making” with their patients when exploring witnessed doses, giving addicts some control over whether their use of free opioids was monitored or not. They were further allowed to put patients on a partially witnessed system, where their first daily dose would be observed and the remainder taken home for unsupervised use.

Generally speaking, the guidelines allowed safer supply prescribers to evade witnessed consumption requirements so long as they could loosely claim that, in their subjective opinion, doing so was beneficial to the patient. As such prescribers often have a deep ideological commitment to safer supply, or financially benefit from it, this system was highly vulnerable to abuse.

Dr. Leonora Regenstreif, a Hamilton-based addiction physician, told Canadian Affairs last summer that the guidelines seemed “deliberately confusing” and would simply allow prescribers to carry on as before. Dr. Michael Lester, a Toronto-based addiction physician, similarly told the publication that prescribers would be in compliance with the guidelines even if “none of their patients are transferred to witnessed dosing.”

In the weeks after the new guidelines were published, B.C. Premier David Eby told the provincial legislature that most safer supply patients had been moved to a witnessed-only model. Yet, it turned out that the province was not actually tracking how many patients were receiving unwitnessed safer supply, meaning Eby had no figures to back up his claim.

“Since the witnessing is an instruction on a prescription (not a code), the ministry does not currently have the ability to track witnessed vs. unwitnessed doses centrally and in real time,” said the B.C. Ministry of Health in a statement to B.C.-based journalist Rob Shaw in May.

Evidently, the system needed tweaking.

Earlier this month, the province released new guidelines — which come into effect on Dec. 30 — mandating witnessed consumption for all safer supply patients. These guidelines still allow unwitnessed doses in exceptional circumstances, but qualifying criteria now match those used for traditional addiction medications such as methadone, which means that they are clearer and stricter than before.

While this is an improvement, it is still possible that some clinicians will creatively interpret these criteria to prescribe unwitnessed safer supply opioids to diversion-prone patients. If there is a lesson to be learned from the past few years, it is that many safer supply prescribers cannot be trusted to practice responsibly — many of them even claim that opioid diversion is a good thing.

So British Columbians will just have to wait and see how much fraud persists, and pray that Eby will finally start tracking and publishing the relevant data.

National Post