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Topic

Prescribed Safer Supply Policymaking in BC: A Qualitative Analysis of Problematizations, Intervention, and Evidence Making during Dual Public Health Emergencies

Social Dimensions of Health

Date & location

• Wednesday, August 27, 2025
• 4:00 P.M.
• Virtual Defence

Examining Committee

Supervisory Committee

• Dr. Bernie Pauly, School of Nursing, University of Victoria (Supervisor)
• Dr. Bruce Wallace, School of Social Work, UVic (Co-Supervisor)
• Dr. Jaime Arredondo Sanchez Lira, School of Public Health and Social Policy, UVic (Outside Member)

External Examiner

• Dr. Carla Treloar, Centre for Social Research in Health, University of New South Wales, Sydney

Chair of Oral Examination

• Dr. Cornelia Bohne, Department of Chemistry, UVic

Abstract

In British Columbia (BC), the unregulated toxic drug supply has become the leading cause of premature death among people in their most active and productive years. Although the province declared a public health emergency nearly a decade ago, toxic drug deaths have continued to escalate signaling the limitation of public health responses to date. The COVID-19 pandemic further intensified these harms, as public health directives reduced access to harm reduction services and direct care to people who use drugs, while international border closures destabilized an already volatile unregulated drug supply.

In the context of dual public health emergencies, BC introduced the Risk Mitigation Guidance (RMG) in March 2020, to empower eligible prescribers to facilitate access to pharmaceutical-grade alternatives to opioids, stimulants, and benzodiazepines to individuals at risk of withdrawal, overdose, and/or COVID-19 infection. Some defined RMG as an initial model of prescribed safer supply.

The dual public health emergencies created an opening for novel drug policymaking in BC. However, significant gaps remain in our understanding of how policymakers defined the problems and envisioned policy solutions to an increasingly toxic drug supply. In this research, I aim to analyze the decision-making and policymaking processes during the implementation of RMG to understand how the province of BC: a) interprets the current unregulated toxic drug emergency; b) intervenes with policy instruments to address identified issues; and c) how those policy instruments respond to the public health emergency from the perspective of people who use drugs in BC. The dissertation is organized into three papers and is guided by a qualitative interpretive research approach, informed by policy studies, poststructural and critical theories.

In paper one, I examine how health policymakers problematized the dual health emergencies and then critically interrogate how RMG came to be a policy response. I use Carol Bacchi’s (1999) “What is the problem represented to be?” framework showing that RMG was a contingency measure to COVID-19 rendering the unregulated toxic drug supply as a secondary issue to a communicable disease infection. Competing interpretations of RMG among policymakers reflected tensions about RMG’s aims and in the implementation process.

In paper two I examine the diverse ways RMG was understood and implemented across different geographies in BC. I use the Evidence Making Intervention (EMI) conceptual framework developed by Rhodes and Lancaster (2019) to understand the local factors that shaped RMG’s implementation throughout the province. I identify that RMG resulted in dynamic and context-dependent interventions that were enacted either as a COVID-19 response, or as a harm reduction tool to disconnect people who use drugs from the unregulated toxic drug supply. I argue for localized evaluations of prescribed safer supply, as evidence of the intervention is begin generated as it is implemented in local contexts, producing different forms of evidence and contextual effects.

In paper three I asked people who use drugs to describe their local unregulated drug markets and key indicators of safety and danger from their perspectives. Through thematic analysis (Braun & Clarke, 2008), I identify user-defined experiences of safety and danger in local unregulated drug markets and highlight policy interventions such as scale up of safer supply, drug check and drug regulation to support community’s efforts in procuring safety. Together, the three papers offer an integrated policy analysis of prescribed safer supply, ultimately foregrounding the perspectives of people who use drugs in the evaluation, in assessing the effectiveness and relevance of policy interventions that directly impact their lives.