December 2, 2025: The province has released a new policy for prescribed alternatives. It takes effect on December 30, 2025, and requires prescribed alternatives to be witnessed by health professionals. The BCCSU has developed the Clinical Bulletin Prescribed Alternatives Policy, replacing our Interim Clinical Resource on Prescribed Alternatives.
April 29, 2025: The BCCSU has developed an interim clinical resource to support the safe transitions of existing clients from non-witnessed to witnessed doses. This resource is now approved by the BC Ministry of Health for clinicians.
February 19, 2025: The Province of BC announced changes to the prescribed alternatives policy, which will now require all prescribed alternatives to be witnessed by health professionals. This requirement goes into effect immediately for all new clients only. This supersedes the guidance previously published by the BCCSU, including the Opioid Use Disorder Practice Update.
Overview
In July 2021, the Ministry of Mental Health and Addictions, Ministry of Health, and Office of the Provincial Health Officer released Access to Prescribed Safer Supply in British Columbia: Policy Direction, which enabled individuals to access a range of medications through prescription to reduce the risk of drug toxicity death due to accessing the illicit drug supply. Prescribed alternatives are an important option that healthcare professionals can use to help separate people from the unregulated, toxic and unpredictable drug supply – and save lives.
On February 19, 2025, changes to the provincial policy were announced to require prescribed alternatives to be witnessed by health professionals. The policy statement stipulated phasing-in the witnessed consumption of prescribed alternatives, with the requirement for immediate implementation for new clients. This policy change supersedes the guidance previously published by the BCCSU related to prescribed alternatives, including the Opioid Use Disorder Practice Update.
To support the safe transitions of existing clients from non-witnessed to witnessed doses, the BCCSU developed an Interim Clinical Resource Transition to Witnessed Dosing for Prescribed Alternatives. This resource was approved by the Ministry of Health for implementation into clinical practice on April 29, 2025. On December 2, 2025 the BCCSU issued a new Bulletin: Updated Prescribed Alternatives Policy—Implications for Clinical Practice, approved by the Ministry of Health for implementation as of December 30, 2025. This replaces our Interim Clinical Resource.
Background
Prescribed alternatives are not intended for treatment of substance use disorders but are primarily a harm reduction approach as one strategy for reducing the risks of illicit drug toxicity events and deaths.
Under the direction of the Ministry of Mental Health & Addiction and Ministry of Health, the BCCSU developed the below clinical resources, including protocols, as part of a phased approach to support the implementation of emerging approaches for prescribed alternatives in BC.
The protocols are targeted specifically for Health Authorities looking to implement in their regions.
Monitoring, evaluation, and data collection of prescribed alternatives is ongoing. Protocols include direction for prescribers to include “SA” in prescriptions, which tells the dispensing pharmacist to tag the prescription with a (non-public) identifying code, for program evaluation purposes, in PharmaNet.
These protocols will be updated as evidence is collected and practices are evaluated.
New (December 2, 2025):
Note: A Guideline for the Clinical Management of Opioid Use Disorder (OUD Guideline) has been updated to provide guidance on the full continuum of OUD care.
Part 1 of this Opioid Use Disorder Practice Update, originally developed to provide updates on the provision of OAT in line with planned updates to the provincial OUD Guideline, is now considered out of date. In any instances of incongruent guidance between the updated OUD Guideline and the Opioid Use Disorder Practice Update, the guidance contained in the OUD Guideline supersedes the guidance contained in the OUD Practice Update.
The BC Centre on Substance Use has developed a practice update to provide an overview of evidence-based treatment options and introduce new evidence and approaches relevant for those providing care for individuals who use illicit stimulants. This does not represent a comprehensive guideline on management of stimulant use disorder and associated conditions.
These resources provide a standardized protocol for the provision of fentanyl patches to reduce reliance on the illicit drug supply and associated harms.
Provision of other medications for harm reduction is outside the scope of this protocol. See the BCCSU’s Opioid Use Disorder Practice Update (above) for information on prescribing hydromorphone and/or M-Eslon to help reduce individuals’ reliance on the illicit drug supply and, thus, overdose risk; and the BCCSU’s Stimulant Use Disorder Practice Update (above) for information on trialing stimulant prescribing to help reduce individuals’ reliance on the illicit drug supply and related harms.
This protocol is adapted from PHS Community Services Society’s Fentanyl Patch Policy and Vancouver Coastal Health’s Fentanyl Patch Clinical Operational Manual.
- Prescribed Safer Supply Protocols: Fentanyl Tablet (PRN)
- Prescribed Safer Supply Protocols: Fentanyl Tablet (Maintenance)
These resources provide a standardized protocol for the provision of fentanyl tablets as a way to reduce reliance on the unregulated drug supply and associated harms.
Provision of other medications for harm reduction is outside the scope of this protocol. See the BCCSU’s Opioid Use Disorder Practice Update (above) for information on prescribing hydromorphone and/or M-Eslon to help reduce individuals’ reliance on the illicit drug supply and, thus, overdose risk; and the BCCSU’s Stimulant Use Disorder Practice Update (above) for information on trialing stimulant prescribing to help reduce individuals’ reliance on the illicit drug supply and related harms.
This protocol is adapted from PHS Community Services Society’s Fentanyl Tablet Policy.
These resources provide a standardized protocol for the provision of sufentanil as a way to reduce reliance on the unregulated drug supply and associated harms.
Provision of other medications for harm reduction is outside the scope of this protocol. See the BCCSU’s Opioid Use Disorder Practice Update (above) for information on prescribing hydromorphone and/or M-Eslon to help reduce individuals’ reliance on the illicit drug supply and, thus, overdose risk; and the BCCSU’s Stimulant Use Disorder Practice Update (above) for information on trialing stimulant prescribing to help reduce individuals’ reliance on the illicit drug supply and related harms.
This protocol is adapted from PHS Community Services Society’s Sufentanil Policy.