British Columbia’s opioid crisis has entered a new and complex phase, with recent investigations revealing that a significant portion of prescribed opioids intended for harm reduction are being diverted into illicit markets. A leaked briefing from the Ministry of Health confirms that pharmaceutical-grade opioids, distributed under the province’s safe supply program, are not reaching their intended recipients. Instead, these drugs are being trafficked within British Columbia, across Canada, and beyond. Allegations of financial incentives offered by pharmacies, housing providers, and medical professionals have raised concerns about systemic vulnerabilities that allow prescription medications to enter the street supply.
The leaked document, prepared for law enforcement, outlines a pattern of pharmacy-driven diversion, where more than 60 pharmacies have allegedly offered financial incentives to patients and prescribers. The province’s PharmaCare system, designed to ensure medication accessibility, has reportedly seen dispensing fees reach $350 million annually, nearly triple the amount recorded two decades ago. Meanwhile, tens of millions of doses of opioids, primarily hydromorphone, have been prescribed through safe supply since 2022, with a significant share redirected to street-level sales. This raises questions about oversight, accountability, and the unintended consequences of harm reduction policies.
The diversion of safe supply opioids extends beyond economic fraud. Reports indicate that pharmaceutical opioids obtained through prescription programs are being sold on the street for as little as $5 per pill, making them easily accessible to youth and those without opioid use disorder. Case studies, such as the death of 15-year-old Kamilah Sword, underscore the risks associated with diverted hydromorphone entering the hands of teenagers. As the province expands harm reduction initiatives, critics argue that the absence of regulatory safeguards allows a safe supply to fuel the crisis it was meant to mitigate.
Promises and Pitfalls of Safe Supply in British Columbia
British Columbia’s safe supply initiative was introduced as a response to the province’s ongoing opioid crisis, which was declared a public health emergency in 2016. The program was designed to provide pharmaceutical alternatives to illicit drugs to reduce overdose deaths caused by an increasingly toxic street supply. Hydromorphone, a prescription opioid, became a central component of this approach, offered as a safer substitute for fentanyl and other high-potency street opioids. Supporters of the initiative argued that by ensuring access to regulated substances, the province could mitigate the risks associated with unpredictable and lethal contaminants in the illegal drug trade.
While the policy aimed to curb overdose fatalities, it also led to a sharp rise in opioid prescriptions. The number of prescriptions for opioids distributed through BC’s PharmaCare system increased significantly following the program’s expansion. Health officials noted that these medications account for only about 14% of all prescribed opioids in British Columbia, but the increase in availability created new opportunities for misuse and diversion. Reports from health agencies and law enforcement began to raise concerns that a portion of these medications was not being consumed by the individuals to whom they were prescribed but was instead entering secondary markets through unauthorized distribution.
Inconsistencies in oversight have compounded the challenges of regulating safe supply. Unlike supervised opioid agonist therapy programs, which require in-clinic administration of medications like methadone or Suboxone under direct medical supervision, many prescriptions under the safe supply model allow patients to take home their medications. This flexibility, intended to reduce barriers to care, also makes monitoring whether the medications are used as intended difficult. Critics have pointed to gaps in tracking and enforcement, warning that without stringent controls, the program could inadvertently contribute to the same street-level opioid trade it was designed to replace.
How Prescription Opioids Are Diverted From Patients to the Streets
The increase in opioid prescriptions under British Columbia’s safe supply program has coincided with growing concerns over how these medications are being distributed beyond their intended recipients. While the program was designed to provide a controlled alternative to the toxic illicit drug supply, reports indicate that prescribed opioids, particularly hydromorphone, have become readily available for street purchase. Individuals enrolled in the program have been documented selling or trading their prescriptions, often using the proceeds to obtain fentanyl or other substances. According to Fiona Wilson, the deputy chief of the Vancouver Police Department and president of the BC Association of Chiefs of Police, approximately 50% of hydromorphone seizures in British Columbia can be attributed to diverted safer supply drugs. The resale of safer supply medications has contributed to a shifting drug market, where pharmaceutical-grade opioids are accessible for significantly lower prices than unregulated alternatives.
Law enforcement and addiction experts have identified multiple points in the distribution chain where diversion occurs. Some pharmacies have allegedly played a direct role by offering incentives to patients and healthcare providers, encouraging the selection of specific locations for dispensing prescriptions. Regulatory reports suggest that financial incentives for opioid prescriptions are more widespread than publicly acknowledged, prompting scrutiny of pharmacy oversight. Community housing providers have also been implicated, with reports that certain staff members direct residents to specific pharmacies in exchange for monetary benefits. These practices allow high volumes of opioids to circulate beyond their prescribed use, undermining the program’s intended safeguards.
The diversion of prescription opioids has reshaped the landscape of illicit drug use, creating a secondary market that operates in parallel with the province’s harm reduction efforts. As pharmaceutical opioids circulate beyond their intended recipients, they are altering supply chains and shifting drug consumption patterns, raising concerns about whether the safer supply is being co-opted into the same underground economy it was meant to disrupt. The extent to which these medications have integrated into street markets suggests that diversion is not an isolated occurrence but a structural flaw in the program’s design—one that continues to evolve in ways policymakers have yet to grasp fully.
The Hidden Costs of Diversion
The diversion of safer supply opioids has reshaped the illicit drug market in ways that neither policymakers nor harm reduction advocates fully anticipated. Hydromorphone, once considered a controlled prescription medication, is now widely available at low prices on the street, changing consumption patterns among people who use drugs. While the program was designed to reduce reliance on the toxic fentanyl supply, emerging evidence suggests that diverted opioids are being used as currency—sold or traded to finance the purchase of more potent substances. This raises difficult questions about whether the safer supply is effectively addressing opioid dependency or unintentionally reinforcing patterns of substance use.
Some proponents argue that diversion itself is a form of harm reduction—that any pharmaceutical-grade opioid is preferable to illicit fentanyl. By this logic, even if safer supply drugs reach unintended users, they are still reducing the likelihood of fatal overdoses. However, this perspective assumes that diverted medications serve as an adequate replacement for street fentanyl rather than a supplement to existing substance use. Recent findings indicate that many individuals enrolled in safer supply programs continue using fentanyl despite access to hydromorphone, challenging the assumption that pharmaceutical opioids alone can curb demand for more potent substances. In a Vancouver-based study, nearly a quarter of safer supply participants reported selling or trading their prescriptions, and 100 percent tested positive for non-prescribed substances, including fentanyl and methamphetamines.
Beyond the immediate effects on the illicit drug market, the diversion of prescribed opioids has raised concerns about youth exposure. Reports of hydromorphone being sold to teenagers at low cost highlight the unintended reach of safer supply. The case of 15-year-old Kamilah Sword, who died after consuming diverted hydromorphone, underscores the risks of prescription opioids entering broader circulation. While harm reduction advocates emphasize that safe supply has prevented overdose deaths among high-risk populations, the unintended consequences—including increased availability of opioids among non-users—suggest the need for stronger oversight and targeted interventions. Without changes to prescription monitoring and program administration, safer supply may continue to fuel new patterns of opioid misuse rather than functioning solely as a protective measure against toxic drug fatalities.
The Gaps in Oversight and Accountability
British Columbia’s safe supply program operates within a fragmented regulatory system, where responsibility for oversight is divided between the Ministry of Health, the College of Pharmacists, and federal health agencies. While safeguards exist for prescription drugs under Canada’s Controlled Drugs and Substances Act, monitoring at the dispensing level remains inconsistent, creating opportunities for diversion. The reliance on PharmaNet—a system primarily designed for billing rather than preventing misuse—has limited effectiveness in tracking real-time prescription activity, making it difficult to detect irregularities as they occur.
One of the most glaring regulatory failures involves dispensing oversight within pharmacies themselves. While medical professionals are subject to strict prescription guidelines, the BC College of Pharmacists has limited capacity to enforce compliance at the dispensing level. The case of a Vancouver pharmacist who dispensed more than 28,000 naloxone doses to a single individual highlights how large-scale medication misallocation can occur without immediate detection. This incident raises concerns about whether similar loopholes exist in the distribution of safe supply opioids, where high-volume prescriptions can pass through the system without triggering immediate audits. The absence of a real-time alert system for excessive dispensing leaves health officials relying on retrospective investigations rather than proactive enforcement.
In contrast to BC’s reactive approach, other jurisdictions have implemented stricter prescription monitoring programs to curb opioid diversion. Alberta’s real-time monitoring system flags irregular transactions immediately, allowing regulators to intervene before large volumes of medication reach unauthorized recipients. The United States, through the Drug Enforcement Administration, actively investigates and prosecutes cases of prescription opioid diversion, operating a centralized enforcement model that BC lacks. Without stronger auditing mechanisms and timely intervention, diverted opioids will continue to circulate beyond their intended use, undermining both the harm reduction goals of safe supply and the integrity of the prescription drug system.
Can Safe Supply Be Fixed?
At the core of the debate is the question of whether diversion is a policy failure or an inevitable outcome of any large-scale opioid distribution program. Advocates of harm reduction argue that diverted opioids, even when misused, are still preferable to illicit fentanyl, which is responsible for the majority of overdose deaths. In this view, diversion is not a failure but rather a sign of unmet needs within the system—a symptom of addiction-driven economic realities, where individuals trade prescribed drugs to access substances that better manage withdrawal or provide a stronger high. Critics, however, contend that this logic ignores the downstream effects of an expanding secondary market, where opioids initially intended for high-risk individuals are increasingly available to youth and first-time users. When prescription-grade opioids become cheaper and easier to access than street fentanyl, has the province unintentionally created a new entry point into addiction?
The assumption that safe supply alone can reduce overdose deaths has also come under scrutiny. Evidence shows that many safer supply participants continue using fentanyl despite having access to pharmaceutical opioids, challenging the belief that prescription alternatives will displace illicit drugs. If the goal is to reduce fentanyl-related deaths, then why are diverted hydromorphone pills saturating street markets while fentanyl consumption remains high? Some addiction experts argue that safe supply needs to be more tightly integrated with treatment options, such as opioid agonist therapies, which have shown long-term success in stabilizing individuals with opioid use disorder. Others propose that prescription monitoring must be dramatically strengthened, preventing large-scale diversion without restricting legitimate access.
The diversion of prescribed opioids in British Columbia is forcing an urgent reassessment of the province’s harm reduction strategy. The future of safe supply will depend on whether policymakers are willing to confront these contradictions head-on. If diversion continues to outpace the intended harm reduction benefits, the program risks losing public trust and further entrenching the very crisis it set out to solve. Addressing these gaps requires a shift from viewing safer supply as a standalone solution to treating it as one component of a broader, more structured response—one that prioritizes oversight, long-term recovery pathways, and a recognition that reducing overdose deaths is not the same as reducing addiction itself.
Kris has been at the forefront of Downtown Eastside initiatives for over 15 years, working to improve the neighbourhood. As a consultant to several organizations, he played a key role in shaping harm reduction strategies and drug policies. A strong proponent of decisive action, Kris’s work focuses on driving tangible change and advocating for solutions that address the complex challenges facing the community.
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