The authors of that JAMA article seem to confuse correlation with causation. We know that there are about 4,500 people on safe supply in British Columbia, but we also know that there are over 225,000 people who were diagnosed with opioid use disorder and use street-level fentanyl. The idea that we can have a population effect from 5,000 people in the context of a denominator of 225,000 people is not reasonable. Safe supply prescriptions are not prevalent enough to be able to do that. We also need to remember that over 90% of hydromorphone prescribing in British Columbia is actually to chronic pain patients and not to safe supply patients. They're less than 10%.
The reason fatal overdoses have climbed in B.C. is actually because of an increase in the volatility in the supply. During that time period, we have seen the introduction of benzodiazopenes and xylazine to the toxic supply. People are dying because the fentanyl they're using is more deadly.