A man walks by a COVID-19 alert in Vancouver's Downtown Eastside, ground zero of B.C.'s overdose crisis. Photo by Jonathan Hayward / The Canadian Press

British Columbia has scrambled to put in place a new strategy to stop the COVID-19 pandemic and the opioid epidemic from crashing together.

The plan allows doctors to prescribe prescription drugs as a replacement for street-level heroin, fentanyl, and methamphetamines. The new rules even empower pharmacies to deliver the medication directly to users, so that they can continue to self-isolation amid the global pandemic.

The guidelines build on smaller pilot projects that have run over the past few years, enabled by an exemption granted by the federal government under the Controlled Drugs and Substances Act. These guidelines, however, are the first time that replacement opioids and drugs will be widely available and regulated.

“It’s a step, it’s good,” says Garth Mullins, a harm reduction activist in Vancouver’s Downtown Eastside, and host of the Crackdown podcast. “But it’s bittersweet. Why did we have to wait so fucking long? Have so many people dead?”

Mullins says just like traders on Wall Street turning bearish with fears of trade disruptions, dealers in Vancouver are already warning that that supply may be disrupted. That means users could be facing painful withdrawal, and may turn to other, dicier, sources for their drugs. That threatens to compound the still-burning overdose crisis.

Some users switched to methadone as the COVID-19 outbreak got worse, Mullins says, “because they were anticipating shortages.”

Methadone has been a long-standing heroin alternative, but it is not much-loved by users—governments have maintained incredibly stringent restrictions on how users can get methadone, and withdrawal can be debilitating as well.

The new B.C. guidelines give doctors pretty wide latitude to prescribe replacements to those illicit drugs (what’s known as opioids agonist therapy, like methadone) or to prescribe pharmaceutical opioids, like oral morphine.

Mullins and a loose-knit coalition of drug user activists have been calling for these policies for more than a decade.

“You’re hopeful but you’re pissed off,” he says. “And you realize well this is a step, so it’s good, but there’s more to come.”

With cities across the continent virtually shutting down amid COVID-19 fears, accessing safe consumption sites has been significantly harder. They’ve had to reduce capacity, go with fewer staff, and some have even had to close their doors. “It’s rough all around,” Mullins says. There are fears that the most vulnerable users have gone back to using alone, at home, putting themselves most at risk of a deadly overdose.

“Am I worried about more overdoses?” Mullins says. “Fuck yes I am.”

B.C. has encouraged users to buddy up—while still observing social distancing—in case they overdose and require medical attention. But even overdoses pose a new risk in the time of COVID-19, as providing oxygen to someone becomes riskier.

The new prescription guidelines will, if they are followed, actually reduce the number of overdoses altogether.

Thomas Kerr and M-J Milloy are both professors at the University of British Columbia who study substance abuse and addiction. They penned an op-ed in the National Post, calling out the difference in responses to the two emergencies.

“Why listen to the scientists and public health experts in one case, but not the other?” They wrote. “The coronavirus outbreak is certainly an acute concern, but we have been in the midst of an opioid crisis for years and we’re not going to lessen its impact on society unless our elected leaders are able to get over the stigma surrounding substance abuse and use the best available scientific evidence to help solve the crisis.”

The steps taken by B.C. are, without question, the most ambitious harm reduction strategy in North America—but it’s not clear if anyone is set to follow suit. Any province could issue similar guidelines, but thus far none have. Some, like Alberta and Ontario, have recently tried to scale back the availability of safe consumption sites, a harm reduction tool that has been universally praised by available research as a life-saving measure.

In B.C., though, it took a global pandemic to get the government to move. Mullins admits he and others will need to keep pushing, even to ensure that these measures continue once COVID-19 has been beaten.

“I have hope, that’s the program,” he says from self-isolation in Vancouver. “I know we’ll have to fight and scrape, and we’ll have to expand it. And it’ll have to be part of a kind of giant freshet of social programs.“