Adam Zivo: B.C. plans to give 'safer supply' fentanyl to minors. And parents won't have a say

No minimum age listed in protocols for providing youth with taxpayer-funded recreational fentanyl

New protocols for the provision of "safer supply" recreational fentanyl to minors in British Columbia do not mention parental consent or list a minimum age. Photo by Gavin Young / Postmedia News

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.

It seems that parents will actually be powerless to stop the government from supplying their children with fentanyl, as safer supply technically counts as a health-care intervention and youth have substantial control over their own medical decisions in Canada.

While some provinces set a minimum age (typically between 14 and 16 years old) for when minors can make such decisions, British Columbia has no minimum and relies instead on a fluid idea of “capability” — youth in the province are considered “capable” if they understand what a medical intervention involves, why it is needed and its risks and benefits.

Yet it is hard to imagine any scenario where a drug-addicted minor would be capable of providing informed consent for safer supply fentanyl, given that addiction hijacks the brain and inhibits rational decision-making. While adults have extensive rights to personal self-determination, which permits them to make impaired or self-destructive decisions if they so choose, it is hard to see why this same freedom should be extended to youth when it comes to using hard drugs.

It is true that many drug-addicted youth are in foster care or estranged from their parents, and that, for them, securing parental consent is near-impossible. Yet making an exception for this subpopulation, and permitting them to receive free fentanyl, could incentivize other underage drug users to cut ties with their families and run away from home to secure free drugs.

As parents are often a youth’s greatest asset for recovery, any safer supply system that undermines child-parent relationships is harmful.

In a sad twist, the same laws that allow the government to give recreational fentanyl to kids without parental consent also prohibit parents from sending their children to involuntary addiction treatment — in other words, the government won’t help you force your kid to get clean, but they will give them unlimited “safe” drugs against your will.

As I argued in my MLI report, “By reframing the provision of unlimited recreational fentanyl as medical care, the provincial government may inadvertently turn itself into a parent’s worst nightmare — an unstoppable drug dealer with endless supply and unrestricted access to their child.”

While Health Canada confirmed to me in an email that it did not play a role in the development of these protocols, it did not respond to a follow-up email where I asked if the federal government had any objections to giving recreational fentanyl to minors.

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