Background: In response to the dual public health emergencies of COVID-19 and a longstanding overdose crisis in British Columbia (BC), Canada, interim-clinical Risk Mitigation Guidance (RMG) was released in March 2020, enabling a form of prescribed safer supply for individuals at risk.
Objectives: Provide insights into the construction, interpretation, and implementation of RMG from the perspective of health planners (policymakers, managers, health authority actors) in BC.
Methods: We conducted qualitative interviews (n=28) with health planners from across BC. We used Carol Bacchi’s “What’s the Problem Represented to be?” (WPR) approach as an analytical tool to critically examine the construction of problems and solutions in the RMG.
Results: RMG is a product of an emergency context that opened a window of opportunity for the provision of prescribed safer supply as a policy alternative. The problematization of RMG revealed that it was created in response to the problem of COVID-19, exposing how fear of disease transmission drove a response not seen with escalating overdose deaths. Deprioritizing the overdose crisis created a variety of implementation problems, which led some to question the efficacy of the guidance.
Implications: This study underscores the need for safer supply policy solutions that directly prioritize the unique aspects of the overdose crisis. Using COVID-19 as a primary driver for intervention highlights the limitations of consolidating multiple health crises into a single approach. Findings emphasize the need for alternative ways of thinking about the problem (i.e., non-prescriber models).