“In Vernon we do have clients on a fentanyl patch program that we are including in the prescribed alternative and that seems to be working for them, but I understand it makes total sense that the patch may not be the modality that works for everyone. And if we can have more options for physicians to choose with their patients for what works best and keeps them safe and keep their needs met so they don’t turn to the street supply, then I support it, but I do understand that it is logistically complicated.”
Fenton noted smoking the substance also allows a person to avoid the use of needles, and is the way most people have been consuming street fentanyl.
She stated these, and the other substances, provided through the service are prescribed based on an evaluation of an individual’s needs.
“The criteria for eligibility is very strict, it’s only available to those who have an established substance use disorder for whom the traditional therapy didn’t work, for whatever reason,” Fenton explained, adding the prescriptions can be adjusted to meet a person’s needs or medical goals.
“Some people will need to stay on the same dose for a long time, perhaps indefinitely, and other people, their life circumstances will change and then they’ll adjust their dose accordingly, and some people are in a good situation where they can develop other coping behaviours or they can have the medical need, like if they were self-medicating with street supply, and have those things addressed and then not needed anymore and then decreased over time. Everybody’s different.”
Another piece of the report that raised concerns from the public was the risk of diversion, or having someone access the prescriptions only to sell them on the street.
Fenton stated all programs have some form of risk, and diversion is a risk in the prescribed alternative method, but measures are in place to prevent it from happening.
“On the one hand, I think it’s very important that we monitor and make sure diversion is being minimized as much as possible, but on the other hand, I know that’s already how addiction services approaches its medications because they’re very sensitive that that’s a possibility,” Fenton told Vernon Matters.
“They often do things like have their medications picked up daily and they monitor whether or not those medications are used by the person who’s prescribed through things like urine drug screens to see if those metabolites are in there. And if they’re not, then clearly if you’re not using your medication then you don’t need them, and we can change the prescription. So those kinds of safeguards are definitely in place for at least the programs that I’m familiar with.”
Data from the evaluation of the program showed younger British Columbians were not being exposed to more substances as a result of prescribed alternatives.
The report’s data showed the amount of British Columbians aged 19 to 24 diagnosed with a new opioid use disorder peaked in 2017 and then dropped significantly, with a slight uptick following the COVID-19 pandemic but then falling once again. Meanwhile, the number of youth below the age of 19 being diagnosed with an opioid use disorder has stayed relatively flat since data collection began in 2010.
Though the report found no indication of youth accessing prescribed alternatives without a prescription resulting from an active substance use disorder, Fenton said she would prefer if her children were accessing something from a medical professional rather than off the streets.
“If I was a parent to a youth or someone vulnerable, I would much rather they experiment with something pharmaceutical grade than experiment with street supply because that we know is poison,” the medical health officer told Vernon Matters.
“From a population level, theoretically, if some of these pills were to go missing, I’m much more concerned about the use of street drugs than I am with these pills.”
She added there has been no evidence from the B.C. Coroner’s Service of any deaths linked to prescribed alternatives, and the report did not find any evidence of people developing substance use disorder as a result of using diverted supply, though those two possibilities are always being considered and investigated.
“I’m confident that between monitoring for these outcomes that we are not seeing, and between the safeguards that I know are in place for these programs that are running, that that risk is minimized as much as possible,” Fenton said. She noted the use of diverted supply could pose a risk of an addiction forming, but also said there are several factors that influence addiction.
“It’s important to understand that the risk of addiction doesn’t come from a substance itself, but rather from the psycho-social state of the person who’s doing substances, the environment that they’re in, their set of coping behaviours, the resources they have available to them.”
She compared it to how most people can consume alcohol without developing an addiction while others cannot. She added there should be limits on substances that people can be “unhealthily dependent on” while also ensuring supports and resources are in place to address the other factors. The goal is to ensure an addiction is not developed in the first place.
IH’s top doctor told Vernon Matters she supported the prescribed alternative program and the plan to continue and expand on it, as it is evidence-based and helping people get off the toxic street supply. She added there should also be more investments in safe consumption and overdose prevention sites, as well as drug checking resources.