Report outlines need for rapid expansion of prescription opioids in response to the fentanyl crisis

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      The B.C. Centre for Disease Control and Provincial Health Services Authority have published a radical policy document that outlines a path forward in the fentanyl crisis.

      In addition to traditional ideas such as investing more in treatment, the report includes an entire section on how to best address the “contamination” of B.C.’s illicit drug supply.

      To that end, the document includes the following suggestions:

      • Pilot low-barrier, rapidly scalable models of distributing a regulated supply of pharmaceutical opioids to those at risk of opioid overdose due to illegal drug supply contamination
      • Open additional clinics based on the Crosstown model (on-site injection with intensive engagement) to provide access to supervised opioid injection
      • Expand physician capacity and confidence to prescribe opiates including oral hydromorphone, long acting slow release oral morphine, and injectable opioids

      Today, opioid-substitution therapy, as these sorts of programs are called, is available in Vancouver on a small scale. Roughly 150 patients receive prescription heroin or hydromorphone (commonly known by the brand name Dilaudid) at two locations in the Downtown Eastside. There, patients see a doctor or a nurse to receive regulated doses of opioids that are paid for by taxpayers.

      The report argues for a large-scale expansion of such programs, describing a situation where the B.C. government would become a major supplier of opioids, hypothetically taking people addicted to drugs away from drug dealers and bringing them into the health-care system.

      The document emerged from a June 2017 meeting called the “British Columbia Overdose Action Exchange”. It’s described as “ideas and actions recommended by a range of participants as being necessary to reduce the unprecedented rise in overdose deaths seen over the past two years”.

      Other notable suggestions in the report include enhancing access to drug testing not only among drug users, but also to their dealers.

      “Conduct outreach to local drug producers to improve processing, bulking and access to testing of illegal drugs,” the report recommends. “Encourage drug dealers to use drug testing programs.”

      Going a step further, the report states that B.C. authorities could provide drug dealers with “professional-grade mixing equipment” and “educate them about techniques to improve homogeneity of the product”.

      Another idea floated in the report is to allow people addicted to drugs to grow their own opioids—likely the poppy plant from which morphine and heroin are derived. That could work similar to how Canadian laws allow for the personal cultivation for marijuana for medical purposes.

      Karen Ward is a Vancouver Area Network of Drug Users (VANDU) board member who helped organize drug users’ participation in drafting the document. In a telephone interview, she emphasized that the arrival of fentanyl—a synthetic opioid significantly more toxic than heroin—has created a need for drug-policy reform with an urgency like never before. Ward argued that means policymakers need to make realistic assessments of what’s required to keep people who are addicted to drugs alive.

      “Fentanyl and its analogs have been in the opioid supply for a long time, and that is only increasing,” she told the Straight. “That means that people who at one point were using or thought they were using heroin are now using fentanyl, which is much stronger. Their tolerance has built up dramatically. They need that extent of pain relief simply to manage where they already are. A safe supply, a prescribed supply, needs to recognize that if you can’t get someone to that level, it simply won’t work.”

      At Crosstown Clinic in the Downtown Eastside, patients receive prescription heroin in a medicalized setting.
      Amanda Siebert

      B.C. authorities are already working to expand access to prescription opioids as a tool that could save lives in the fentanyl crisis.

      On July 11, the Straight reported that draft guidelines for injectable-opioid treatment were nearing completion and under review at the B.C. Ministry of Health. And last June, the Straight reported that a doctor working for the Portland Hotel Society has quietly started a program where long-time heroin addicts make daily visits to a Downtown Eastside clinic to receive injectable doses of hydromorphone.

      Ward has repeatedly criticized the government for being too slow with those initiatives given the unprecedented risk that the arrival of fentanyl has meant for people addicted to drugs in B.C.

      In 2017, the province is on track for more than 1,500 fatal drug overdoses, up from 978 in 2016, 519 the previous year, and 369 in 2014.

      Today, however, Ward said the B.C. Centre for Disease Control’s report, as well as the recent election of a new NDP government in Victoria, are reasons for cautious optimism.

      “This isn’t proposing a single solution,” she said. “It is recognizing that there are a lot of intersecting factors, and access to a reliable, clean supply, will keep people alive.”

      B.C.’s new minister of mental health and addictions, Judy Darcy, is quoted in an August 16 media release stating the document is under review.

      “We will be looking at the recommendations closely to determine how they will contribute to our work to implement a seamless system for mental health and addictions in B.C.,” she said.