No break in fentanyl deaths prompts B.C. to speed up efforts to get clean drugs to long-term addicts

The province's minister of mental health and addictions tells the Straight a new Overdose Emergency Response Centre will facilitate rapid responses to the opioid crisis

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      The province is accelerating an expansion of a controversial program where people who are addicted to opioids receive a clean supply of drugs via the province’s health-care system.

      In a telephone interview, B.C.’s minister of mental health and addictions, Judy Darcy, said the goal is to see injectable hydromorphone—a drug very similar to heroin—available in all five of B.C.’s health authorities as soon as possible.

      “We want to get this life-saving treatment into people’s hands,” she told the Straight. “It’s a critical alternative for people for whom first-line therapies don’t work…and I’m pressing as hard as I can to improve access.”

      Darcy said she has assigned the task to B.C.’s new Overdose Emergency Response Centre, which was announced for Vancouver General Hospital on December 1.

      “It’s modelled after a traditional emergency management structure,” she noted. “That’s going to really accelerate everything we’re doing across the board for the overdose crisis.”

      B.C. is on track for more than 1,400 fatal overdoses this year, according to the latest coroner’s report. That’s up from 981 in 2016 and 519 the year before that. In 2017, more than 80 percent of overdose deaths have been associated with the synthetic opioid fentanyl.

      Travis Lupick / B.C. Coroners Office

      Since 2014, a small group of select patients in Vancouver’s Downtown Eastside have received prescription heroin (diacetylmorphine) or hydromorphone (brand name Dilaudid) via injection at a clinic called Crosstown. Because those drugs are controlled and regulated by the government, they’re guaranteed pure, thus eliminating the risk of a fentanyl overdose.

      Dr. Patricia Daly is chief medical health officer for Vancouver Coastal Health (VCH) and the Overdose Emergency Response Centre’s first executive director and clinical lead. She told the Straight that so far B.C. has only made injectable opioid agonist therapy (iOAT), as its formally known, available to patients who have repeatedly failed with traditional oral treatments such as methadone and Suboxone.

      “It is for long-term opioid addicts,” she emphasized. “Having said that…that’s not the only group for whom this might be appropriate, in the midst of the opioid crisis.”

      Because the risks associated with street drugs are now so great, Daly said, B.C. health-care professionals are discussing “lowering the bar” for injectable hydromorphone. (Complicated barriers mean that for now the province is not expanding access to prescription heroin.)

      “In terms of addressing the current [overdose] crisis, we want to engage people in opioid agonist therapy, and if the only way they are willing to start is injectables, let’s start them that way,” Daly said.

      Patients at the Downtown Eastside's Crosstown Clinic visit three times a day to receive a prescribed dose of diacetylmorphine, the medical term for heroin.

      Darcy instructed B.C.’s five health authorities to draft injectable opioid agonist therapy plans last October. She said Daly will now be working with the regional care providers to hurry that process along.

      “Fraser Health has indicated that they have plans under way to have injectables, and Interior Health also wants to offer this. So this is going to be provincial,” Daly said. “And we [Vancouver] only have it in the Downtown Eastside. So even in VCH, we need to make this more broadly available in other places. There are plans under way to do that.”