The growing need to adapt services to address the changing modes of drug consumption

A Q & A with BCCSU research scientist Dr. Geoff Bardwell

Early this year, the BC Coroners Service released a report looking at mode of drug consumption and risk of fatal drug poisoning. The data confirmed what many have known for some time – the way people are consuming drugs is changing and services to support people who use drugs need to adapt to those trends.

Recently, BC Centre on Substance Use research scientist Dr. Geoff Bardwell published a commentary, “More than a pipe dream? The need to adapt safer opioid supply programs for people who smoke drugs.”

We spoke to Geoff about the changes in modes of drug consumption and how services like safer supply need to adapt.

Question: For years, responses to harms associated with illicit substance use have focused on injection drug use. What sort of changes are we seeing in how people are consuming drugs? What ways are mode of consumption impacting risk of overdose?

We know from BC Coroners data that since 2016 there has been an upward trend in the percentage of overdose deaths resulting from smoking toxic drugs (from 31% in 2016 to 56% in 2020). At the same time, there has been a downward trend in overdose mortality from injection (from 39% in 2016 to 19% in 2020). What complicates this reality is the fact that some harm reduction messaging continues to suggest that smoking is safer than injecting drugs. This  may have been true in the past, but in our current context of a highly toxic drug supply, there is increasing evidence of heightened risk of overdose when smoking opioids.

Q: Do you see a gap in how harm reduction and other substance use services are being delivered to adapt to these trends?

There is definitely a gap and we are seeing this across multiple harm reduction programs and services, including supervised consumption services and safer supply programs. Current safer supply programs provide prescription opioids for people to consume orally, intranasally, or intravenously. These options work for people who prefer these consumption methods, but leaves out those who have a preference for smoking opioids. If the intention of safer supply programs is to provide people with safer alternatives to the toxic drug supply, then it follows that these programs should also include smokable options (such as powdered heroin) to prevent those most at risk of overdose death in BC.

Q: As BC and other provinces look at expanding safer supply, what considerations should be made to ensure accessibility for people who consume substances other than through injection?

Provinces across Canada need to immediately expand safer supply programs to include drugs that can be smoked. Importantly, they need to consult local communities of people who use drugs to ensure that programs are meeting community needs. For medicalized models that require witnessed use, establishing supervised inhalation spaces within existing services would be an obvious next step.

However, research demonstrates the social aspect of drug-smoking, so providing people with take-away doses would allow people to continue to smoke their drugs in a social setting rather than in a clinical setting that may isolate individuals from their peers. We do know that a one-size-fits-all approach is not an effective response and we therefore need a multi-pronged approach to safer supply in terms of delivery models, substances offered, and consumption methods in order to adequately respond to this devastating overdose crisis.

Read the full commentary here: