The Canadian province of British Columbia was already years into a public health emergency when COVID-19 arrived: deadly drug overdoses.
A main driver has been the quality of street drugs, which increasingly contain even more potent opioids analogs, like fentanyl, or other substances, like animal tranquilizers.
In response, Vancouver Coastal Health, the region’s main health system, started sending out text alerts if they discovered traces of other drugs laced in heroin or cocaine.
Elana Gordon/The World
There were even warnings about this in bus ads and at bus stops, said Dr. Matthew Chow, a child psychiatrist in the suburbs of Vancouver, and president of Doctors of BC.
Still, over time, the drugs have become more and more toxic. Chow has lost several patients to overdoses. Across the province, thousands have died in recent years.
“...[W]e are pulling out all the stops to try to save lives here,” Chow said.
Along with those very public warnings, the western province expanded treatment; made the overdose-reversing drug naloxone widely available; sanctioned places where people could inject illegal drugs under supervision; and even set up highly regulated clinics where people deemed treatment resistant could take prescription heroin.
In 2019, deaths finally began to dip.
Then — COVID-19 hit.
“Any gains around those deaths are reversed,” said Cheyenne Johnson, director of the BC Center on Substance Use.
The pandemic created an even deadlier cocktail for people who use drugs and who struggle with addiction. People were told to stay home and to socially distance themselves. Health services closed or went remote.
It’s not just Canada. Fatal drug overdoses reached an all-time high in the United States during the pandemic, with 90,000 reported deaths in 2020.
But British Columbia decided to try something untested, and even more out of the box, to address the dueling crises.
Early on, the region introduced a “prescribed safer supply” policy, which made it easier for doctors and nurses to prescribe pharmaceutical equivalents to people who would otherwise turn to street drugs, according to Johnson.
This was meant to protect people from transmitting COVID-19, help them self-isolate in quarantine and help alleviate and manage their withdrawal symptoms and cravings, she said.
The policy builds on years of activists and people who use drugs pushing for a regulated safe supply of drugs. Johnson helped develop the guidelines, including how to assess when it's appropriate.
Henry Fester was one of the early participants.
“I started to get my life back to the point that this is what it used to be like before I lost control."
“I started to get my life back to the point that this is what it used to be like before I lost control, you know?” Fester told The World in the spring of 2020, a few weeks in.
Fester, who had weeks earlier enrolled in a different safe supply pilot, was then able to go to a pharmacy to pick up his supply of pills, which he’d then crush and inject at home every few hours, as needed. At 61 years old, he said it was a total relief because he didn’t have to spend most of his waking hours thinking about how to get his next hit in order to avoid getting violently ill from withdrawal symptoms.
Within a year of these new guidelines, about 6,500 people have taken part in this safe supply program. According to preliminary analysis, no overdose deaths were documented among participants.
Cheyenne Johnson observed an unexpected development in that preliminary assessment. For people with opioid use disorder who took part in the initiative, these medications were "incredibly helpful" to engage people in care who either previously disengaged or only marginally engaged in care, she said.
And yet overall, overdose deaths haven’t let up during the pandemic. They continue to reach record levels. In British Columbia, more people have died from illegal drug overdoses since the start of the pandemic, than from COVID-19.
“I want to acknowledge the losses, the sons and daughters, mothers, fathers, brothers, sisters, friends, leaders, elders who have lost their lives to this toxic drug supply, despite all the work that’s been done,” said Dr. Shannon McDonald, chief medical officer for British Columbia’s First Nations Health Authority, during a press conference this summer. “I wish we didn’t have to be here today.”
Instead of wrapping up the safe supply program, she and other regional leaders announced the opposite: that they would be pouring $22.6 million into the 2021 budget.
“Today we are expanding prescribed safe supply in British Columbia to separate people who use drugs from the increasingly toxic drug supply,” said Sheila Malcolmson, British Columbia’s Minister of Mental Health and Addictions. “We’ve heard from people who use drugs and medical professionals that more options and expanded access to safer supply are needed.”
Malcolmson and others said this new expansion will involve a phased-in approach: Different groups will weigh in as they lay the foundation; they'll develop outreach teams; and work to standardize a more widely available intervention.
Despite the public endorsement, the expansion is going to be a challenge. Even the most adamant supporters of pharmaceutical alternatives are skeptical, including Henry Fester’s doctor, Mark Tyndall, who doubts enough health providers will come on board.
“Physicians still feel that they're under quite a bit of surveillance and quite a bit of restrictions. And most have chosen just not to not to do it.”
“Physicians are still fairly reluctant to use these guidelines because they haven't been endorsed by the colleges and things,” said Tyndall, who has been piloting a different kind of safe supply program for opioids that doesn't depend as much on individual prescribers. “Physicians still feel that they're under quite a bit of surveillance and quite a bit of restrictions. And most have chosen just not to not to do it.”
Additionally, prescriptions — like stimulants in place of meth — haven’t worked for everyone, either because of the amount prescribed or the kind of drug, Tyndall said, adding that for most, it wasn't an adequate substitute.
Members of the Vancouver Network Of Drug Users [VANDU], meanwhile, want greater involvement from people who use drugs in the development of future guidelines and policies. In recent demonstrations calling for greater access to safer drugs, activists openly distributed packets of pure heroin, methamphetamine and cocaine to people.
Martin Steward, a VANDU member and longtime heroin user involved in those protests, said he was able to enroll this past year in British Columbia’s safe supply program. He says it fell short. He and others dropped out.
“The dilaudids [narcotic] they prescribed me [are] nowhere near sufficient enough for me to be a normal citizen,” he said. “They talk to everybody except for people that use drugs or have used drugs. They asked the police and the health minister what we should be allowed to have.”
Others worry this could create easier access to addictive pills.
As for Fester, who started on the safe supply program nearly a year and a half ago, he recently told The World that in the time since, he has felt isolated and lonely. Lots of places are still closed as a result of the pandemic. He said it has been hard to even get out of bed.
“...It's so easy, it's so easy to fall into that big black hole,” he said. “And it's so difficult to crawl out of, like, real difficult to crawl out of.”
Fester wasn’t aware that British Columbia was expanding the safe supply program, but he became more upbeat when he learned about the update. He is still participating in it and thinks that it will absolutely save more lives. Even in this pit of COVID-19 darkness, he said he’s grateful that at the very least, he doesn’t have to take to the streets to find drugs.
“I think it’s great,” he said. “I think it’s beyond great.”