Just have this come from their prescription pad: the medicalization of safer supply from the perspectives of health planners in BC, Canada

Abstract

Context

In March 2020, British Columbia introduced the Risk Mitigation Guidance (RMG) to enable the prescription of pharmaceutical substitutes for the unregulated drug market to decrease overdose deaths and COVID-19 infections. This study presents health planners’ perspectives on the RMG adoption within a medicalized system of care.

Methods

We conducted interviews with 28 health planners to obtain their views on implementation. We undertook a thematic analysis, drawing on the theory of medicalization to analyze and interpret findings.

Findings

We identified four themes regarding the implementation of the RMG within a medical model: (1) The medical model as expeditious and pragmatic; (2) Increasing medicalization of safer supply in response to prescriber tensions and distress; (3) Intersecting harms to people who use drugs; (4) Recommendations for additional safer supply models, decriminalization and regulation.

Conclusions

Health planners recognized and often problematized the over-medicalized nature of current safer supply models. Challenges with medicalization include privileging dominant ideologies (e.g. biomedicine), exerting social control, and perpetuating inequities. Greater attention to the relationships between harm reduction, medical, and criminal justice models in drug policy is needed to avoid compromises of medicalization within criminalization. Grassroots harm reduction may be critical in advancing safer supply beyond medical models.

Keywords:

• Harm reduction
• medicalization
• criminalization
• public health
• safer supply
• drug overdose

Acknowledgments

Our research took place on the traditional, unceded, and continually occupied lands of the over 200 First Nations in what is colonially known as British Columbia.

We acknowledge the contributions of the following team members with lived and living experience who helped to design this study: Shawn Belcourt, Charlene Burmeister, Katt Cadieux, Willow Giesinger, Jenny McDougall, Rebecca McLeod, Josh Pelletier, Heather Spence, Ben Stevenson, Erica Thomson, & Shawn Wood.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research (CIHR, grant number 172 671), Michael Smith Health Research (grant number 18 951), the Victoria Hospital Foundation, and the British Columbia Ministry of Health. AS is supported by a Scholar Award from the Michael Smith Health Research. KU is supported by a Canada Research Chair through CIHR. BP was supported by an Island Health Scholar in Residence Award.