BC coroner's panel calls for an expanded safe drug supply system

A panel of subject-matter experts from the BC Coroners Service has issued a resounding call to expand access to a safer drug supply.

"This report is the result of a tremendous amount of collaboration and problem solving. The experts on the panel were thoughtful, committed, and practical in identifying an approach that can guide future efforts to expand access to viable alternatives to an illicit supply of substances that is only increasing in volatility and toxicity," said Michael Egilson, the panel's leader, in a Wednesday release.

"Our goal was to demonstrate a way forward that reflects a sense of urgency that is commensurate with the scale of the crisis — a way that can be rolled out quickly in order to save lives now."

The chief coroner of British Columbia convened the panel of experts in December 2022, charging them with finding swift solutions to stem the tide of substance-related fatalities in the province.

Their report said the current safer supply initiatives in BC were a step in the right direction but remained ensnared within a medical model. They primarily served individuals with opioid-use disorders who already had access to the healthcare system.

An estimated 225,000 British Columbians used unregulated substances, fewer than 5,000 per month received safer supply prescriptions.

Among the panel's recommendations:

1. The provincial Ministry of Mental Health and Addictions would immediately seek a class exemption to the Controlled Drugs and Substances Act (CDSA) from the federal minister of health and minister of Mental Health and Addictions. This exemption would allow access without a prescription to the class of opioid and stimulant drugs, offering a lifeline to those at risk of dying due to the toxicity of the drug supply in British Columbia.

2. The Ministry of Mental Health and Addictions would spearhead the development of an application process for agencies to obtain licensure and delegated authority to distribute regulated substances without the need for a prescription.

3. The Ministry of Mental Health and Addictions pledged to engage with individuals who had lived or living experience with substance use, as well as family and caregivers, in the planning, implementation, and evaluation processes to ensure the unique needs of those most at risk of dying were met.

4. Collaboration with indigenous leadership was paramount. The Ministry of Mental Health and Addictions, alongside the Ministry of Health and the Ministry of Indigenous Relations and Reconciliation, would further fund, support and engage with indigenous communities to identify Indigenous solutions to the crisis.

Their report called for a robust system of checks and balances to ensure the program's goals were met, and public concerns were adequately addressed. Real-time monitoring and rapid adjustments were to be implemented as necessary.

The release of the panel's report coincided with the BC Coroners Service's monthly update on unregulated drug deaths in the province, which revealed a chilling reality: 175 lives were lost to toxic drugs in September 2023, an average of approximately 5.8 deaths per day.

Unregulated drug toxicity reigned as the leading cause of death in British Columbia for individuals aged 10 to 59, surpassing homicides, suicides, accidents and natural diseases combined. Since the public health emergency was declared in April 2016, the lives of at least 13,112 British Columbians had been lost to unregulated drugs.

"The drug-toxicity public-health emergency is now in its eighth year and the devastating death toll in communities across the province continues to grow," said chief coroner Lisa Lapointe.

"While the concept of safer supply may be challenging for some to understand, the expert members of the panel have provided a thoughtful and careful way forward and out of this crisis. It is clear that safer supply is only one piece in a necessary continuum of care for British Columbians at serious risk of death."

"While that continuum of care is being developed, thousands more of our family members, friends and colleagues are at risk of dying. As the panel found, urgent access to a safe alternative to the current toxic, unregulated, and ever-growing illicit drug market is necessary to keep people alive."