Melissa Steinhauer left a Vancouver medical clinic crying happy tears when she was given a prescription for a “safe supply” of opiates, which have been made more widely available in B.C. due to new guidelines for doctors and pharmacies during the COVID-19 pandemic.
Then, a few weeks later, she left the same clinic in tears after she said a different doctor refused to renew the prescription.
She said the experience was like a “slap in the face.”
“I feel like he was totally oblivious to what safe supply was because he seemed to hum and haw too many times and was very blunt in just saying no,” said Steinhauer.
Now Steinhauer and other advocates for people who use illicit substances are speaking out and calling for better measures to ensure people who qualify to receive safe supply under the new guidelines can have confidence that prescribers won’t turn them away.
The new “safe supply” guidelines were announced in late March in response to the COVID-19 pandemic. Health officials were concerned about the illicit drug supply becoming even further adulterated because of disrupted global supply chains, further exacerbating the ongoing overdose crisis, and about people being able to access their treatment while in self-isolation.
B.C. declared a public health emergency in response to the overdose crisis four years ago.
“There are more people that died from the fentanyl overdose than from COVID-19,” said Laura Shaver, president of the B.C. Association of People on Opiate Maintenance.
Between January and April there were 382 illicit drug deaths in B.C. There have been 162 deaths from COVID-19 in B.C. this year.
Province says there is ‘more work to do’ on rollout
Shaver said the move toward safe supply is a positive step but she’s concerned that people are having difficulty finding doctors who are willing to prescribe medications like Dilaudid (hydromorphone), as opposed to opiate replacement therapies like methadone or Suboxone.
Shaver said there’s a vast difference.
“Suboxone and Dilaudid are so different it’s not even funny,” she said.
“Dilaudid is to mirror and give you the euphoria high of the opiate you want. Suboxone is to take that away and make sure you can’t get that high.”
The province doesn’t have a full picture yet of how many people are benefiting from the new safe supply guidelines to date, but limited data shows there is uptake. The prescriptions people are accessing range from opiate therapies to pharmaceutical stimulant replacements.
The new guidelines also capture people being treated for dependence on tobacco, benzodiazepines and alcohol.
In an emailed statement, B.C.’s Ministry of Mental Health and Addictions stated that its team is watching closely for uptake of the guidance, “and listening to feedback from patients and prescribers.”
The ministry stated it’s committed to updating the guidance as needed and said “there is still more work to do to reach everyone who needs it and the prescribers who can make that happen.”
The B.C. Centre for Substance Use has been providing training to health care professionals on the guidelines and the province says more than 1,500 people have taken the training to date. The training is directed at both prescribers and pharmacies.
Prescription requires daily trips to the pharmacy
Steinhauer’s problem with her safe supply began at the pharmacy, where she was picking up her medication daily.
After missing two days of her daily pickup, she was told she’d have to go back to the doctor to get a new prescription, which she didn’t think would be a problem.
“You go in there hoping to get the same thing because you got it from the same clinic so you think all the doctors were on the same page. No.”
Since her Dilaudid prescription was cut off, Steinhauer said she’s turned back to street drugs, which has people around her concerned and angry.
“To me this is like a penalty so if somebody misses a dose — bam, they go right back to where they started,” said Tracey Draper, program co-ordinator with the Western Aboriginal Harm Reduction Society where Steinhauer is the board secretary.
“She can’t get her prescription. So she’s back to square one, which bothers me.”
Laura Shaver said there are countless reasons why someone might miss their daily pickup at the pharmacy and it’s cruel to cut someone off.
On top of that, she said Steinhauer is now at an “extremely high risk of overdose.”
“And that makes me livid. Absolutely livid,” she said.
Shaver and Draper said it’s also alarming that someone who lives and works in the Downtown Eastside, who works as an advocate for drug users, could have this kind of experience. It makes them especially concerned for people in other parts of the province.
Steinhauer said she’s committed to finding a doctor who will get her back on the safe supply.
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