Theme: Social Science & Policy Research Year: 2022
Background:
Dual public health emergencies, the COVID-19 pandemic and an ongoing toxic drug supply crisis
linked to escalating drug overdose deaths in British Columbia (BC) were the impetus for the creation
of the interim Risk Mitigation Guidance (RMG) in March 2020, that permitted prescribing medication
alternatives to substances, including opioids, alcohol, stimulants and benzodiazepines, an
intervention sometimes referred to as ‘safe(r) supply’.
Methods:
This study is part of a research program established to evaluate implementation and impacts of RMG
in BC and relies on collaboration with people with lived or living expertise (PWLLE) of drug use. We
surveyed 352 residents of BC who had received or were trying to access a prescription (such as
tablet opioid hydromorphone and stimulant Dexedrine) to replace or supplement an illicit
substance. A sub-sample of 55 participants were identified during the quantitative survey and
invited to participate in 1-hour qualitative interviews between November 2020 and September 2021.
Results:
Access to RMG was limited, most often facilitated through urban prescribers, drug user groups and
outreach teams. While PWLLE saw RMG as a step in the right direction, dosing was too low to stop
withdrawal and not in a form to adequately replace current fentanyl or stimulant use. Current
policies and structures for Opioid Agonist Treatment (OAT) provision were used for RMG
implementation: daily dispensing through pharmacy, often in tandem with witnessed OAT, and
Urine Drug Screens. PWLLE encountered drug related stigma, racism, discrimination, and
surveillance that acted as barriers to accessing RMG and reproduced distrust in their relationships
with prescribers.
Conclusion:
The implementation of RMG through the same mechanisms as OAT prescriptions reduced access to
RMG and reproduced structural vulnerabilities previously identified as barriers to OAT. The legacies
of provincial policies around OAT provision have had a negative impact of the experience of RMG
implementation.
Disclosure of Interest Statement:
The conference collaborators recognise the considerable contribution that industry partners make to
professional and research activities. We also recognise the need for transparency of disclosure of
potential conflicts of interest by acknowledging these relationships in publications and presentations.
MS has received grants through CACHC from Kirby Institute, Gilead, and ViiV. KU is supported by a
Canada Research Chair through CIHR. BP is supported through the Island Health Scholar in Residence
funded by Island Health.