Provide regulated opioids to stem overdose crisis, medical experts say

VANCOUVER B.C. medical experts say a regulated legal drug supply is key to reducing an epidemic of overdose deaths.

A report released on Friday by Vancouver Coastal Health makes 21 recommendations to reduce fatalities, including expanding prevention and treatment programs and distributing legal opioids on a trial basis.

“We need to go beyond just treatment,” said chief medical health officer Patricia Daly. “We need to consider a regulated drug supply to replace the illegal drug supply.”

The report notes 90 per cent of more than 2,600 opioid samples tested from October 2017 to December 2018 contained fentanyl, the powerful opioid responsible for more than 80 per cent of the 2,741 overdose deaths the B.C. Coroners Service recorded from 2016 to 2018.

In Vancouver, 87 per cent of deaths in 2017 involved fentanyl.

Prevention workers have noticed recently that opioids are being combined with anti-anxiety medications called benzodiazepines, which result in overdoses that front-line treatments such as naloxone can’t fully reverse.

“It just shows the challenges of an illegal drug supply,” said Daly. “We don’t know what the next contaminant might be.”

Proposed safe supply models mentioned in the report include legal opioids administered at safe consumption sites and heroin compassion clubs, where a group of users could purchase and share the drug.

Christy Sutherland, a medical director for the Portland Hotel Society, said programs such as these would save lives and millions of tax dollars that would otherwise go toward policing drug use and responding to overdoses caused by contaminated drugs.

“If you’re worried about your kids using drugs, the system we have now is the one you don’t want,” she said.

Existing treatment options include opioid substitution therapy, where users are prescribed drugs such as methadone to replace illicit substances. Sutherland prescribes hydromorphone to roughly 200 patients from her clinic in the Downtown Eastside and said there is a long wait list.

The report found only 39 per cent of the 447 users who died in Vancouver in 2017 were believed to be daily opioid users, meaning many fall outside the umbrella of substitution therapy.

“People who are alcohol users and meth users who are using opioids to help with withdrawal or help them sleep — they don’t have those treatment options ... or the tolerance,” said Sutherland.

The report suggested expanding prescription access to stronger opioids, which could be more effective substitutes for fentanyl, as well as loosening rules around the supervision of consumption.

“Most of my patients would prefer to have heroin rather than hydromorphone,” Sutherland said.

Scott Macdonald is the lead physician at Providence Crosstown Clinic, which prescribes diacetylmorphine, or prescription heroin. He welcomed the report and said health officials should focus on expanding existing heroin prescription programs before pushing for complete drug regulation, which the federal government has said it is opposed to.

“We can’t wait. We need to get these treatments out,” he said. “The supervised model is the one that can expand immediately.”

He points to a Canadian pilot program that resulted in Denmark immediately expanding prescription heroin access. He said he is frustrated this hasn’t happened at home.

Daly says one of the barriers to increasing availability of prescriptions is supply, because much of the legal heroin is bought from Switzerland. She and Macdonald believe domestic production is necessary.

There are currently roughly 100 people in Vancouver with such a prescription. Donald Macpherson, the executive director of the Canadian Drug Policy Coalition, estimates at least 800 could be eligible.

He also welcomed the report, but said the extent of the crisis demands immediate measures from the provincial and federal governments to regulate the drug supply, not a pilot project.

“Starting a pilot program and monitoring it for a year or so is fine. But tonight, there are thousands of people at risk of overdosing in British Columbia that could be accessing safe supply,” he said. “I understand the risks of broadening it exist. I think the risks of not doing it are far greater.”

There are thousands of people at risk of overdosing in British Columbia that could be accessing safe supply.