Participation in B.C.’s safer supply program — which offers prescription opioids to people who use drugs — has dropped by nearly 25 per cent over the past two years, according to recent government data.

The B.C. Ministry of Health says updated prescribing guidelines and tighter program oversight are behind the decline.

But addiction experts say the story is more complicated.

“Many of my addiction medicine colleagues have stopped prescribing ‘safe supply’ hydromorphone to their patients because of the high rates of diversion … and lack of efficacy in stabilizing the substance use disorder (sometimes worsening it),” said Dr. Launette Rieb, a clinical associate professor at the University of British Columbia and addiction medicine specialist.

“Many doctors who initially supported ‘safe supply’ no longer provide it but do not wish to talk about it publicly for fear of reprisals,” she said in her email.

Missing data

B.C. has had safer supply programs in place province-wide since 2021.

Participation in its program peaked at nearly 5,200 individuals in March 2023, and then declined to fewer than 3,900 individuals by December 2024. This is the most recent data publicly available, according to B.C.’s health ministry.

In an emailed statement, the ministry attributed the decline to updated clinical guidance and more restrictive prescribing practices “aimed at strengthening the integrity and safety of the program.”

In February, the province updated its safer supply prescribing guidelines to require most patients of the program to consume prescription opioids under the supervision of health-care professionals — a practice known as “witnessed dosing.”

The B.C. government has not released any data on how many patients have been transitioned to witnessed dosing.

The ministry did not address Canadian Affairs’ questions about whether patients are being cut off involuntarily from the program, whether fewer physicians are prescribing or whether barriers to accessing safer supply have increased.

‘Dependence, tolerance, addiction’

Some experts say the decline in safer supply participation is due to physicians being influenced by their peers and public controversy over the program.

Dr. Karen Urbanoski, an associate professor in the Public Health and Social Policy department at the University of Victoria, says peer influence plays a significant role in prescribing practices.

A 2024 study found the uptake of prescribed safer supply in B.C. was closely tied to prescribers’ professional networks.

“These peer influences are apparent for both the uptake of [safer supply] prescribing and its discontinuation — they are likely playing a role here,” Urbanoski said in an email to Canadian Affairs.

Urbanoski also points to the broader environment — including negative media coverage and uncertainty about program funding — as factors behind the decline.

“Media discourse and general politicization of [safer supply] has likely had a ‘cooling effect’ on prescribing,” she said.

Dr. Leonara Regenstreif, a primary care physician and founding member of Addiction Medicine Canada, says many physicians embraced safer supply without fully grasping its clinical risks. Addiction Medicine Canada is an advocacy group representing 23 addiction specialists across Canada.

Regenstreif says physicians too young to have practiced during the peak of OxyContin prescribing were often enthusiastic prescribers of safer supply in the program’s early days. OxyContin is a prescription opioid that helped spark North America’s addiction crisis.

“In my experience, the MD colleagues who have embraced [safer supply] prescribing most zealously … never experienced the trap of writing scripts without knowing what was ahead — dependence, tolerance, addiction, consequences,” her emailed statement says.

Now, many of these physicians are looking for an “exit ramp,” Regenstreif says, as concerns over safer supply diversion and its treatment benefits grow.

Reib, of the UBC, says some of her colleagues in addictions medicine fear speaking out about their concerns with the program.

“Some of my colleagues have had their lives threatened by their patients who have become financially dependent on selling their [hydromorphone],” said Rieb.

The College of Physicians and Surgeons of B.C., which represents physicians in the province, referred Canadian Affairs’ questions about declining program participation to the health ministry and the BC Centre on Substance Use. The centre was unable to provide comment by press time.

Public backlash

The decline in B.C.’s safer supply participation unfolds amid mounting scrutiny of the program and its effectiveness.

Rieb says that the program’s framing — as free, safe and widely available — may run counter to longstanding public health strategies aimed at reducing drug use through pricing and harm awareness.

“Drivers of public use of substances are availability, cost, and perception of harm,” she said. “[Safe supply] is being promoted as safe, free and available for the asking.”

There have been reports of youth gaining access to diverted safer supply opioids and developing addictions to fentanyl as a result. Last September, B.C. father Gregory Sword testified before the House of Commons that his teenage daughter died after accessing diverted safer supply opioids.

B.C.’s recent decision to overhaul its prescribing guidelines followed revelations of a widespread scam by dozens of B.C. pharmacists to exploit the safer supply program to maximize profits.

Experts also note that Canada still lacks the evidence needed to assess the long-term health outcomes of people in safer supply programs. There is currently no research in Canada tracking these long-term health outcomes.

“There is a lack of research to date on retention on [safer supply],” said Urbanoksi.

Rieb agrees. “There are many methodological problems with the recent studies that conclude [the] benefit of pharmaceutical alternatives (‘safe supply’),” she said.

“We need long term studies that look at risks/harms as well as potential benefits.”

Regenstreif says the recent drop in participation may have an unintended upside — encouraging more people with substance use disorders to try what she sees as a more effective treatment: opioid agonist therapy, or OAT. This therapy uses medications like methadone or buprenorphine to reduce withdrawal symptoms and cravings.

“If fewer people are accessing [safer supply] tablets … more people with [opioid use disorder] might accept proper OAT treatment,” she said.

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.