Participation in British Columbia’s safer supply program has plummeted by nearly 25 per cent over two years, raising serious questions about a controversial initiative that provides prescription opioids to drug users.

Troubling government data reveals that the safer supply program peaked at nearly 5,200 participants in March 2023 before declining sharply to fewer than 3,900 by December 2024. Whilst the BC Ministry of Health attributes this decline to updated clinical guidance, addiction specialists warn of deeper problems with the approach.

However, addiction specialists paint a more troubling picture of medical professionals retreating from a policy they once championed.

Medical Professionals Voice Concerns

Dr Launette Rieb, a clinical associate professor at the University of British Columbia and addiction medicine specialist, says many colleagues have abandoned safer supply prescribing due to fundamental problems with the approach.

“Many of my addiction medicine colleagues have stopped prescribing ‘safe supply’ hydromorphone to their patients because of the high rates of diversion… and lack of efficacy in stabilising the substance use disorder (sometimes worsening it),” she explained.

“Many doctors who initially supported ‘safe supply’ no longer provide it but do not wish to talk about it publicly for fear of reprisals.”

Some physicians report more serious consequences. Rieb reveals that colleagues have faced threats from patients who became financially dependent on selling their prescribed hydromorphone.

Professional Networks Drive Change

Dr Karen Urbanoski, an associate professor at the University of Victoria, points to peer influence as a significant factor in prescribing decisions. A 2024 study found that safer supply program uptake in BC closely correlated with prescribers’ professional networks.

“These peer influences are apparent for both the uptake of [safer supply] prescribing and its discontinuation — they are likely playing a role here,” Urbanoski noted.

She also highlighted broader environmental factors, including negative media coverage and funding uncertainty, as contributing to what she described as a “cooling effect” on safer supply prescribing practices.

Learning from Past Mistakes

Dr Leonara Regenstreif, a primary care physician and founding member of Addiction Medicine Canada, suggests that younger physicians who embraced the safer supply program lacked historical perspective on prescription opioid risks.

“In my experience, the MD colleagues who have embraced [safer supply] prescribing most zealously… never experienced the trap of writing scripts without knowing what was ahead — dependence, tolerance, addiction, consequences,” she stated.

These physicians, who missed the peak of OxyContin prescribing that helped spark North America’s addiction crisis, are now seeking an “exit ramp” from safer supply prescribing as concerns mount.

Policy Changes and Oversight

The provincial government updated safer supply program guidelines in February 2024, requiring most patients to consume prescription opioids under healthcare professional supervision through “witnessed dosing.”

However, the BC government has not released data on how many patients have transitioned to this supervised model or whether patients are being involuntarily removed from the program.

The ministry declined to address questions about whether fewer physicians are prescribing or whether access barriers have increased.

Alarming Consequences Emerge

The declining participation unfolds amid disturbing reports of program failures and unintended harm. Reports have emerged of young people accessing diverted safer supply opioids and subsequently developing fentanyl addictions – precisely the opposite of the program’s stated goals.

Last September, BC father Gregory Sword testified before the House of Commons that his teenage daughter died after accessing diverted prescription opioids from the safer supply program.

Rieb argues that the program’s framing contradicts established public health principles. “Drivers of public use of substances are availability, cost, and perception of harm,” she said. “[Safe supply] is being promoted as safe, free and available for the asking.”

Evidence Gap

Experts consistently highlight the lack of robust research supporting the safer supply program. Canada currently has no studies tracking long-term health outcomes for participants.

“There is a lack of research to date on retention on [safer supply],” Urbanoski observed.

Rieb echoed these concerns: “There are many methodological problems with the recent studies that conclude [the] benefit of pharmaceutical alternatives (‘safe supply’). We need long term studies that look at risks/harms as well as potential benefits.”

Alternative Treatment Approaches

The declining participation may have an unintended benefit, according to Regenstreif. Fewer people accessing safer supply prescribing might encourage more individuals with substance use disorders to try opioid agonist therapy (OAT), which uses medications like methadone or buprenorphine to reduce withdrawal symptoms and cravings.

“If fewer people are accessing [safer supply] tablets… more people with [opioid use disorder] might accept proper OAT treatment,” she suggested.

The program’s evolution highlights critical concerns about harm reduction approaches that may inadvertently increase risks rather than reduce them. As medical professionals retreat from safer supply prescribing, questions mount about whether such programs truly serve the public interest or simply perpetuate dependency under the guise of treatment.

Source: Break The Needle