What does the safe supply report actually say?

Good morning,

I’m sure you, like me, are glued to the news, trying to find out as much as you can about the attempted assassination of Donald Trump. It’s a massive moment in US history, and it’s hard not to speculate on what it could mean for the future of their country — and given that country’s role on the global stage, it could have rippling effects for the rest of us.

But why don’t you spare your mental health a bit and take a moment away from the doomscrolling to read the Lookout? Get a little local news in your brain! Today, we’ve got a deep dive into Dr. Bonnie Henry’s report on safe supply.

—Dustin Godfrey, freelancer

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WEATHER

Monday: 25 🌡️ 15 | ☀️

Tuesday: 28 🌡️ 17 | 🌤️

Wednesday: 28 🌡️ 17 | 🌤️

DEEP DIVE

What does the safe supply report actually say?

As deaths continue to escalate from the toxic drug crisis in BC, Premier David Eby quickly put an end to speculation on whether or not the province would heed yet another report by health officials calling for expanding safe supply to a non-prescriber model.

• Okay, maybe he didn’t actually end the speculation for some. While he said there was a “zero per cent chance” the province would implement the recommendations in Dr. Bonnie Henry’s report, according to The Canadian Press, that hasn’t stopped the BC Conservatives from campaigning on social media, tying it to the BC NDP.

Background: Last week, Henry released her report, Alternatives to Unregulated Drugs: Another Step in Saving Lives, and one columnist suggested we don’t need to read it, since the BC NDP won’t touch its recommendations with a 10-foot pole. But journalism is about looking deeper than the headlines, and in this case at what is being recommended and why, as the discourse hasn’t engaged with the depth of the report.

• Henry is far from the first to put out a report recommending a non-prescriber model for safe supply. Drug user groups have long advocated for this kind off model, with the Drug User Liberation Front even going so far as to just go ahead with their own model, a move that has landed two organizers with criminal charges.

But late last year, after DULF was raided by the VPD, the BC Coroners Service put out the third Death Review Panel report, which similarly recommended a non-prescribed safe supply model. That recommendation came from a large panel that spanned public health professionals, health care professionals, researchers and police.

Contributing factors: The primary driver of deaths from unregulated drugs in BC is prohibition, the report says, calling toxic drugs a “predictable outcome.” But prohibition doesn’t just create a toxic drug supply — the report notes that there is an association between recently being incarcerated and an increased risk of drug poisoning, particularly within two weeks of leaving prison or jail.

• While men are significantly more likely to die from an overdose, women who use drugs are more likely to experience gendered and racialized violence, and Indigenous and 2SLGBTQ+ people are more likely to experience drug-related harms, including death.

Not prescribing or addictions: One issue commonly attributed to opioid overdose deaths is over-prescribing, but the report says this isn’t the case in BC today — as the number of patients who were prescribed opioids decreased by 12% from 2013/14 to 2018/19, and the number of patients with high-dose opioid prescriptions decreased by 17%, the number of people who died from unregulated drugs in that time more than quadrupled.

• Similarly, while most solutions put forward today revolve around treatment, the report notes that those with substance use disorders are far from the only ones at risk of dying — one study cited found 72% of people with a history of incarceration and who died from an overdose didn’t have a substance use disorder diagnosis. In fact, new diagnoses of opioid use disorder declined between 2017 and 2022, the report notes.

Paradox of prohibition: The report cites a paradox presented by John Marks, which places drugs on a spectrum running from strict prohibition to heavy regulation to free market legalization, and proposes the harms to be greatest at the prohibition and free market approaches, with issues minimized in a legal but heavily regulated market approach. It wraps this up in a quote from Marks:

• “We could not conceive, if we deliberately tried to do so, of a more socially destructive, individually criminalizing, health damaging, expensive and efficient way of making heroin available than we do now, under prohibition. Having no legal supply, the state abdicates, by default, the source of supply to gangsters.”

Alternatives: With the problems fuelled by prohibition, the report moves on to alternatives to the unregulated supply by providing regulated drugs. Given the province already has a prescriber model for safe supply, the report fairly quickly turns to looking at differences between prescriber and non-prescriber models.

• While some have suggested Henry’s recommendations would put drugs on store shelves, you may be surprised to learn the 100-plus page report is more nuanced than the political discourse. It notes that, without a prescriber, “other control mechanisms such as access or eligibility criteria and protocols to minimize harms to individuals and the population would be established instead.”

The report’s recommendations doesn’t prescribe (excuse the pun) how a non-prescriber model should be rolled out, only saying implementing such a model should be explored “with appropriate safeguards.” However, some have latched onto a section of the report that includes a variety of potential approaches — picking out one particular scenario in which products could be sold in a regulated retail space.

The evidence: While the evidence base for safe supply is still building, there have been positive results. One study looking at nearly 6,000 prescribed safer supply recipients found those who received opioid safe supply in BC saw a 61% decrease in all-cause mortality in their first week of receiving their medications, a figure that increased to 91% when recipients got their medications for four or more days.

• Another study of the DULF program found reductions in non-fatal overdoses (there were no fatal overdoses associated with the program), while preliminary data from DULF have shown a suite of positive impacts, ranging from reduced police interactions to reduced exposure to violence and beyond. And a study out of London, Ont. found reductions in ER visits and other positive health effects for recipients of safe supply in that city.

In fact, Henry’s report has well over 30 different citations to evidence showing benefits of prescribed safe supply programs, from reduced risk of fatal and non-fatal overdose and physical and mental health improvements to a range of social and economic benefits.

• “While much of the published research is qualitative, it is aligned with the available quantitative findings, which consistently support similar conclusions: prescribed alternatives programs show benefits and considerable promise in reducing risk of death and improving quality of life for those enrolled in programs,” the report notes.

Those opposed: In opposing the recommendations, Eby said he has “huge respect” for Henry, but that there are times when “what the public health official feels would be the best course of action and what is political reality,” according to The Canadian Press. He also cited recommendations to reduce speed limits to 30 km/h as an area where he has disagreed with public health officials.

The BC Conservatives, meanwhile, called for Henry’s “immediate dismissal” over the report, calling her recommendations “deeply troubling, shocking and irresponsible,” according to CP.

Challenges with prescribers: BC’s safe supply program peaked early last year at less than 5,200 recipients at one time, a figure that has since dropped to less than 4,400 recipients in June this year, according to the BC CDC’s unregulated drug poisoning emergency dashboard. This is despite estimations that up to 225,000 people in the province access the unregulated drug supply each year, according to the report.

• Prescribers have described being anxious about prescribing opioids to patients, including due to the risk of diversion. Diverted opioids, the report notes, have long been available through the illicit drug market, and the report acknowledges the need for ongoing monitoring to determine how much this is actually occurring.

Potential new models: The report looks at a range of ways the province could expand beyond a prescriber model for safe supply. This could include a licence to purchase, wherein people would have to take training on health risks and harm reduction and pass a test to be able to buy the drugs and with monitoring or tracking of drug buyers; a similar model but without tracking buyers; or a “general availability” model, acknowledging most people can self-manage their use.

• These could come through community-led models, like compassion clubs or co-ops, citing DULF as an example.

Zoom out: The issue has been contentious not only provincial, but also at the federal level, with Conservative addictions critic Laila Goodridge taking an excerpt describing a potential retail-based approach to a non-prescriber safe supply model and calling it the “NDP-Liberals’ wacko new proposal.”

• On top of cancelling some safe consumption sites, the Conservatives have also brought motions to end safe supply programs. If they do, they are likely up for some court challenges, as have been brought by advocates over rolling back decriminalization and over Stephen Harper’s government’s decision to end InSite — a court case the government lost.

But Conservative Leader Pierre Poilievre has flirted with the notwithstanding clause, an override in the constitution that could put a quick end to any court fights. 

VANCOUVER NUMBERS

🏢 $20.8 million: The Hotel Georgia penthouse is on sale for this much — and while that is a lot, it’s well below the $35.8 million it was once listed for. [Vancouver Sun]

🚰 $10 billion: The Iona Island Wastewater Plant upgrade comes with this price tag, spurring concerns by politicians about what the ultimate cost could be after the North Shore wastewater project ballooned from less than $1 billion to nearly $4 billion. [Global]

⛏️$7.3 billion: Teck Resources sold off the last 77% of its coal business for this much to Glencore after the federal government approved the transaction. [Vancouver Sun]

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THE AGENDA

🏘️ Metro Vancouver real estate may be heading into a buyer’s market, with several months of cooling sales and rising inventory behind us — but one realtor says he’s waiting to see if buyer activity catches up before coming to any conclusions. [Vancouver Sun]

🏖️ Life’s a beach — but you’ll have to pay up, as the last of Vancouver’s free beach parking, at Spanish Banks, has finally fallen. Beachgoers will now have to pay $1 an hour if they’re parking there during the summer. [Global]

🧑‍🏫 A UBC professor is being investigated by the university for a since-deleted Twitter post about the attempted assassination attempt on Donald Trump. Karen Pinder, from the faculty of medicine, reportedly wrote, “Damn, so close. Too bad.” [CTV]

🏈 The Saskatchewan Roughriders’ undefeated streak couldn’t withstand the BC Lions, who extended their own streak to four games with a 35-20 win on Saturday at BC Place. [CBC]

🚒 A green space in Chinatown that would have been an offramp for the freeway that was planned to run through the area has potential new plans: a temporary firehall to complement the overwhelmed firehall at Main and Powell. [Vancouver Sun]

🤢 Lost Lagoon is an iconic locale in Vancouver, but one West End resident says it’s become a “44-acre mud puddle,” with a park board commissioner saying it’s a matter of money to clean it up. [Global]

🐻 This isn’t exactly a Vancouver story, but bear with us — Coquitlam RCMP had to attend a Belcarra property after a bear was found having locked itself inside a car. [CBC]

💉 BC univer​​sities will now have to make nasal naloxone available on campus as part of the provincial government’s response to the fatal overdose of 18-year-old University of Victoria student Sidney McIntyre-Starko. [Global]

🚬 A Vancouver resident’s parody tune Butt It, a riff on Michael Jackson’s Beat It, is reminding smokers not to be an ass and stop tossing butts in places where their embers can start fires. [CBC]

🥘 Vancouver General Hospital is getting a culinary boost, including “Indigenous cultural safety” as a principle in its menu reform program. I’ll wait for Geoff’s review of the menu before making any effort to go there, though. [The Tyee]

GOOD NEWS MONDAY

Start your day off with some good news:

The Vancouver Symphony Orchestra often goes through numerous national and international auditions before finding the musician perfectly suited for their needs. But when music director Otto Tausk heard Julin Cheung playing, he knew he had his new assistant principal flute and piccolo player — only, they’ll have to wait a year for Cheung to finish high school before he can join. Yes, the new member is only 17 years old. [The Canadian Press]

EVENT GUIDE

Celebration of Light | Concord Pacific | Jul. 20, 24 & 27 | So. Many. Drones. | Tickets $68

Summer Movie Nights | šxʷƛ̓ənəq Xwtl'e7énḵ Square (Vancouver Art Gallery North Plaza) | July 18, 5 PM | Join us this Thursday for Indiana Jones and the Last Crusade! Get ready for spectacle moments by high-flying and action-packed performers before the movie begins! | Learn more [Sponsored]

Made in 604 Summer Pop-up Market | Heritage Hall | Saturday and Sunday | The second of three instalments of the summer pop-up markets this season | Free admission

Frozen | Queen Elizabeth Theatre | Until Sunday | Cool off with this Disney-favourite-turned-Broadway-musical | Tickets $48

Vintage Expo 2024 | Vancouver Art Gallery | Sunday | The Granville Flea-vent of the summer | Free admission

The Cup | Hastings Racecourse | Saturday | Get fancy! Watch horses! | Tickets $75

Vancouver Folk Fest | Jericho Beach | Friday to Sunday | The iconic music festival is back with too many artists to name | Ticket prices vary

Burnaby Pride | 6550 Bonsor Ave. | Saturday | Can’t wait till Vancouver’s Pride? | Free admission

PHOTO OF THE DAY

Chinatown was looking a little overgrown recently for shooting of The Last of Us Season 2.

COMMUNITY HIGHLIGHTS

• Vancouver’s downtown alleys are starting to look a little more inviting — and more is yet to come. [CTV]

• The Northern Pitch is a free, five-minute newsletter summarizing the biggest soccer games across the country (including the Whitecaps). Subscribe to their newsletter today. [Sponsored]

• Eleven canoes arrived in Vancouver, ending a long journey for hundreds of paddlers. [Vancouver Sun]

• Dogs are getting more than kibble at these restaurants. [CTV]

• Attendees of a comedy show got a little “WTF!” moment with a surprise appearance. [Vancouver Sun]

• Spain had a lot of friends on the Drive yesterday afternoon. [CTV]  

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