SAFE AND SAFER

I’ve been writing about this province's epidemic of overdose deaths and related themes for a while now. Just in recent times I’ve covered: the confusion and doublespeak coming from well-intentioned “safe supply” advocates; how we do the opposite of established best practices and actually have a “harm [production] strategy”; how we created a ideal model for exploitation by organized crime; how the previous Provincial Health Officer, mentor of the current one, and person who implemented “safe supply” [sic], started a pharmaceutical company to provide opioids to the province; the outlandish assertions of the Chief Coroner; and on and on…

This week we have a study, titled Safer Opioid Supply, Subsequent Drug Decriminalization, and Opioid Overdoses and published in JAMA Health Forum, looking at evidence for a reduction of overdoses associated with “safer supply” [sic] and the decriminalization of drug possession in British Columbia.

An international team of researchers (from the School of Pharmacy and Memorial University in Newfoundland, the College of Pharmacy at the University of Manitoba, and Weill Cornell Medicine College in New York) compared cohorts in BC with those in other provinces who didn’t implement such “harm reduction strategies” [sic] for the period between 2016 and 2023. Their findings will, doubtless, shock you. (Are you ready? Sit down and grip the table.)

They found that the province prescribing clean and safe, pharmaceutical-grade opioids resulted in a sharp spike in opioid hospitalizations which never declined. Overall, “safe(r) supply” [sic] gifted the population here in British Columbia with a 33% increase in opioid overdose hospitalizations. The research team also determined that decriminalization has resulted in no alleviation of the opioid crisis and that, in fact, opioid hospitalizations took a sharp increase again after public health authorities [sic] and the province implemented their decriminalization policies. For the period where supply and decriminalization were paired, the team showed, both were responsible for an increase in overdose hospitalizations of 58%. 

What of opioid overdose deaths, then? Well, they tell us “There was insufficient evidence to conclusively attribute an increase in opioid death rates to the policy changes in either the safer supply period or safer supply plus decriminalization period.” Said another way: there was no obvious reduction in overdose deaths despite a whole suite of harm reduction strategies (including: take-home, mail-in, to-you, and on-site drug testing and drug supply; clean materials programs; drug vending machines and safe use sites; ubiquitous overdose kits; decriminalization and reduced policing; universal trainings for unconscious bias, cultural safety, and trauma-informed practices; crisis and mental health supports; peer support programs; new and varied housing strategies; and more…)

Relatedly, BC just published new preliminary numbers for unregulated drug deaths. January of 2025, the latest numbers, saw among the highest death count for any month ever recorded, with more overdose fatalities than any month in 2014, 2015, or 2019, and more deaths than six months in 2014. And, in case you're wondering, no fentanyl or fentanyl analogues were detected in 35% of those overdose fatality cases; around 45-50% of cases included cocaine, meth, or benzodiazepines; and only 17% included other opioids such as heroin, oxycodone, hydromorphine, etc... So that means that even the total elimination of that particular scourge or even all opioids would likely still result in overdose figures remaining above historical rates, with still a daily death count in this province alone. Right.

To my mind at least, then, it does seem like lowering stigma, improved care and information, along with easier access to drugs only attracts more participants to both legal (and illegal) drug markets — resulting in more harm. Or, where's the damn counter-evidence?

TWO QUESTIONS: 

• At this point, how can the outcomes described in this study and published in provincial reports plausibly be unintended outcomes?

• Why was any study needed, given that we have monthly and annual overdose and death counts (like stock numbers or climate reports) and the picture has only ever trended in the wrong direction with every new health and safety tool added?

I know, what if we stop killing people and instead treat folks like we would our own family members? Bold strategy, I know. But what if we gave it a shot? Or, if you don't like that, what if we just followed the Portugal model — the only working model the world has ever had? Maybe 20,000 more (disproportionately males in their prime) need to die or a hundred more studies need to be conducted before we finally have the conclusive evidence we need to change policy?