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‘Significant deficiencies’ in programs to curb toxic drug deaths: B.C auditor

Overdose prevention services, prescribed safe supply not properly implemented
Auditor-General Michael Pickup found “significant deficiencies” in the implementation of two “integral” policies designed to reduce the harms caused by B.C.’s illicit drug toxicity, including at least 14,000 deaths since 2016. (Screencap)

B.C.’s auditor general says two key provincial programs intended to help the toxic-drug crisis that has resulted in at least 14,000 deaths since 2016 were not “effectively implemented.”

Auditor-General Michael Pickup’s review, released Tuesday (March 19), looked at provincial overdose prevention and supervised consumption sites, as well as the prescribed safer supply program.

“A prominent theme runs through both of these audits and that is that the Ministry of Mental Health and Addictions and the the Ministry of Health have not effectively addressed the many challenges and barriers facing each program,” Pickup said in a news release.

The audit found the ministries’ guidance didn’t include minimum service standards that ensured consistent quality and access of services, that it did not adequately respond to barriers such as local government resistance and that a new program evaluation was needed as the health emergency evolved.

Pickup’s audit of safer supply found the ministries didn’t make “significant progress” in tackling its “most challenging barriers,” such as rural access to the program, health-care providers’ hesitancy about prescribing the drugs and whether the drugs being offered were appropriate.

Both ministries have accepted all seven recommendations from the reports, including improving minimum service standards, increasing public reporting and addressing a lack of doctors who prescribe safer supply drugs.

The audit also pointed to what Pickup described as the province’s failure to overcome significant municipal resistance to overdose prevention sites. Municipalities have used bylaws, zoning and permitting to prevent the establishment of such sites.

Overdose prevention sites monitor people at risk of toxic drug poisonings and provide drug testing kits, as well as readily-available Narcan in the event of an overdose. Supervised consumption sites allow people to use drugs under the supervision of trained staff without the risk of arrest for drug possession.

As of June 2023, there were 47 overdose prevention and safe consumption sites in B.C., according to the report.

RELATED: Bonnie Henry to review B.C.’s safe supply program

Pickup’s report says that government’s failure to overcome municipal resistance and other roadblocks, such as staff retention at these facilities and infrastructure, has heightened various risks – the most serious being increases in death and injuries due to the circulating toxic drugs.

“Many thousands of people in B.C. are grieving the losses of family and friends from the toxic-drug supply,” Pickup said. “The crisis is also an immense challenge for those working to provide care and support for people who use substances. My team and I have a deep sense of empathy for everyone who has been touched by this continuing tragedy.”

The audit also highlighted several obstacles found within the implimentation of the safe supply program, which the province has rebranded as “prescribed alternatives.”

That program allows physicians or nurse practitioners to prescribe pharmaceutical-grade alternatives for people at risk of harm or death from the toxic drug supply.

Critisism by the auditor general include the unavailability of drugs in a form that can be smoked, as well as the perceived low potency of hydromorphone, and the lack of access in rural communities.

RELATED: Widespread safe supply drug diversion in B.C. ‘simply not true’: Farnworth

Other aspects the report highlights includes a lack of reliable and publicly available data about the program’s effectiveness and geographic reach. Pickup’s report also takes aim at the province’s communication around expansion of the program and the types of drug alternatives available to those in need.

“We found that health-system partners and some health authorities believe that communication by the ministries about prescribed safer supply, specifically about diversion, has been weak,” the report reads.

Addictions Minister Jennifer Whiteside declined an interview Tuesday, but said in a statement that the government is building a continuum of care “that includes prevention, harm reduction, treatment and recovery.”

“While we have rapidly expanded access to overdose prevention sites as a critical tool to keep people alive, we acknowledge there are some persistent barriers impacting implementation and service standards,” she said. “In the same way, while monitoring is in place for our prescribed alternatives program, we continue to work directly with prescribers to support implementation.”

She said the ministry is already working to address many of the items cited in Pickup’s reports.

At an unrelated news conference on Tuesday, Premier David Eby acknowledged the reports’ findings of barriers to accessing those prevention services, especially in remote parts of B.C.

“There are big challenges for us in delivering rural health care, period, and including in the areas where people are struggling with addiction at risk of overdose,” he said. “It’s important to note (Pickup’s) not saying stop the program, he’s not saying the program doesn’t work, he says he wants more of it in every part of the province. This is a challenge for us.”

The auditor’s report said overdose-prevention and safe-consumption sites provide safer environments for people to use drugs under the supervision of a health-care professional or harm-reduction worker to monitor for signs of drug toxicity.