In what constitutes a clear trampling of parental rights, British Columbia recently authorized the provision of “safer supply” fentanyl to youth across the province, regardless if parents are informed of, or agree to, this measure.
The provincial government has provided limited access to safer supply fentanyl since at least 2020, primarily through small-scale pilot projects. However, last August the British Columbia Centre on Substance Use (BCCSU), an influential research organization, published protocols permitting doctors and nurses to prescribe “safe” fentanyl tablets to adults and minors. The organization confirmed to me in an email that it had been contracted by the province to produce these documents “to further support clinicians prescribing safer supply across the province.”
While the B.C. government generally promotes its commitment to safer supply, it was oddly silent in this instance. I became aware of the new protocols only because two concerned addiction physicians contacted me shortly after their publication.
As there has been zero media coverage of this development — excluding a report I authored for the Macdonald-Laurier Institute (MLI), published last month — the provincial government has been able to ramp up the distribution of “safe” fentanyl with almost no public scrutiny.
This is a shame, as the new protocols are full of red flags, including a jarring near-absence of safeguarding measures when giving fentanyl to minors, to say nothing of the obvious ethical issues around underage consent.
The only special requirements for underage patients is the use of a “two prescriber approval system,” wherein one prescriber conducts the patient intake interview and another reviews the client’s charts before signing off.
A number of addiction experts have criticized this as deeply inadequate. Dr. Leonora Regenstreif, a Hamilton-based addiction physician, said she found it hard to imagine that two doctors or nurses working in the same clinic would significantly challenge each others’ prescribing decisions.
The protocols do not provide a minimum age for when youth can receive recreational fentanyl. When I asked the BCCSU whether a minimum existed, they did not reply.
The documents also make absolutely no mention of the rights and roles of parents of drug-addicted minors.
In an email, I asked the BCCSU: i) why the fentanyl protocols made no reference to parents; ii) what would the organization say to parents who do not want their children to receive “safe” fentanyl; iii) whether the BCCSU believes that drug-addicted youth can provide informed consent regarding “safe” fentanyl; and iv) what can parents do if they believe that their children are being harmed by safer supply fentanyl?
The BCCSU did not respond to these queries, despite generally answering other emails of mine over the past year.
If the province is going to dole out recreational fentanyl to minors, it should probably have strong evidence backing this decision — but apparently it doesn’t.
The protocols clearly state that, “To date, there is no evidence available supporting this intervention, safety data, or established best practices for when and how to provide it.” In fact, “a discussion of the absence of evidence supporting this approach” is actually required for securing informed consent from patients.