By Ashley Shapiro
In the face of the growing toxic drug crisis – a disastrous public health emergency felt around the world – British Columbia has been a leader in harm reduction strategies aimed at saving lives and offering safer alternatives to those at risk of overdose. The Prescribed Alternatives Program (PAP) is one such initiative, designed to provide people who use substances with a legal, controlled alternative to dangerous street drugs, reducing the risk of overdose from an unpredictable source.
However, the BC government has announced recent changes to the program which have raised significant concerns, particularly the new requirement that health professionals must witness the consumption of all prescribed alternatives.
This change marks a significant departure from the program’s original focus on dignity and autonomy. Rather than expanding support, these changes are based on a “tough-on-crime” mentality, an approach that is increasingly being taken by the province’s NDP government which is reinforcing stigma and further criminalizing individuals who are already vulnerable.
In a province where thousands of lives have already been lost to the toxic drug crisis, this rollback in harm-reduction policies threatens to undermine the progress made and leaves many questioning the true priorities of the government.
In early February, BC Minister of Health Josie Osborne released a statement reflecting on the lives lost to the toxic drug crisis in BC in 2024. Osborne acknowledged the BC Coroner’s Report, stating, “Today, we acknowledge the 2,253 people in British Columbia who lost their lives to poisoned drugs in 2024. Behind every number is a child, parent, sibling, friend or neighbor, and their loss is felt deeply by those who knew and loved them.”
While the acknowledgment of these lives lost is an important recognition of the scale of the crisis, the recent changes to the PAP seem to run counter to the compassion needed in such a dire situation.
The new requirement for health professionals to witness the consumption of prescribed alternatives will further stigmatize individuals who use substances. Rather than providing a safer, more accessible alternative to toxic street drugs, these changes impose an additional layer of surveillance and control over vulnerable populations. This shift reflects an increasing tendency to criminalize addiction rather than treating it as a public health issue, reinforcing a punitive approach that places greater emphasis on regulation than on recovery.
It is no question that the BC government made this decision based on a punitive narrative that puts tough-on-crime politics above people’s health. In the official announcement of these changes, Osborne quips, “Prescribed alternatives have been proven to save lives by providing a safer option for people at high risk of overdose. We are requiring that the use of prescribed alternatives must be witnessed by a health professional. This will remove the risk of these medications from ending up in the hands of gangs and organized crime.”
While the intention behind this statement may be to assure the public that the government is tackling issues of diversion and criminal activity, it frames people who use substances as criminals, rather than individuals in need of healthcare and support.
Rural communities in BC will likely feel the impact of these changes more acutely than urban areas, where healthcare resources are already scarce. For example, people who receive prescribed alternatives may be required to attend a pharmacy two, three or even four times a day, instead of being provided the autonomy to manage their own medications. The new mandate for health professionals to witness the consumption of prescribed alternatives could create significant barriers for individuals in remote regions, where access to healthcare providers is limited and travel distances to clinics or pharmacies are long.
This requirement not only makes it harder for people in rural communities to access life-saving support but could also discourage them from seeking help altogether. Additionally, the time and effort needed to comply with these new rules will hinder rural residents’ ability to secure employment, address other healthcare needs or fully participate in social and community activities. This further isolates them from essential services and support networks, increasing the risk of overdose.
The underlying intention in the government’s messaging is clear: people who use prescribed alternatives are potential threats, requiring surveillance and oversight to ensure they don’t misuse or sell their medications.
This policy change fails to address the root causes of the toxic drug crisis – namely, the contamination of the illegal drug supply and the lack of accessible, compassionate care for those struggling with addiction. Instead, it shifts the burden onto those seeking safer alternatives, further stigmatizing them in the process. Rather than expanding harm reduction efforts and focusing on the needs of vulnerable populations, this policy prioritizes control and criminalization, reinforcing an approach that is ultimately more about punishment than health and recovery.
In light of these significant changes, one might reflect on Osborne’s concluding statement on the lives lost in 2024: “We know there is still more to do. By working together and continuing to expand life-saving services, more people can find their pathway to recovery.” Osborne’s and the BC government’s statements ring hollow when their actions continue to push further in the opposite direction. Instead of expanding access to life-saving resources, the recent policy changes risk further isolating and criminalizing those who need help the most.
It remains to be seen whether the government will truly prioritize the health and well-being of its citizens or continue to prioritize control over care.
[Photo of Vancouver rally in 2021: drugpolicy.ca]
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