Alleyway docs jump into crisis
Replacement therapy distributed to drug users scared of dying from fentanyl overdose
Yet more powerful drugs are being pushed in the alleyways of Vancouver’s Downtown Eastside.
Dr. Christy Sutherland, medical director for PHS Community Services Society, says they’re fast-acting and drug users are desperate to try them.
Suboxone and methadone — which Sutherland, along with a team of nurses and other physicians, has recently been distributing in alleyways and other sites in the neighbourhood — are proven treatments for opioid dependency.
And with an overdose crisis killing hundreds of British Columbians this year, many drug users are finally ready to put their dependency behind them, Sutherland said.
“People want treatment,” she said. “The people in the Downtown Eastside are scared and they’re scared of dying. They’ve had so much loss and so much death.”
Friday, Vancouver police announced nine people died of an overdose Thursday, including eight in the Downtown Eastside. The B.C. Coroners Service later revealed a total of 13 died provincewide.
Fed up with news of drug users dying, Sutherland said she’s working to quickly get as many of them as possible “up to a nice therapeutic dose of Suboxone and methadone” and off street drugs, which dealers are increasingly tainting with lethal doses of cheap fentanyl.
Suboxone contains buprenorphine and the overdose-reversing drug naloxone. Liquid methadone isn’t as safe but works better for some patients.
In late November, Sutherland and her team began running weekend “outreach clinics” to get opioid users started on the two treatments, with 15 patients starting on methadone during the first weekend.
The program is run at 10 locations, including the Downtown Eastside street market, converted hotels, shelters and in alleyways such as the lane behind 58 West Hastings St., where the province recently set up its mobile hospital and where volunteers with the Overdose Prevention Society have been running an unsanctioned supervised-injection site.
The team sets up a tent, table, chairs and laptops, and offers drug users both substitution therapies depending on their need.
Sutherland estimates team members are doing up to 25 new starts each week as they “go out there to capture patients into care.”
She’s seen a shift in patients’ drug use and in their willingness to begin treatment.
“I’ve had patients say, ‘Well, I’m not using cocaine anymore because I’m worried about fentanyl,’” she said.
“They’re stressed because their friends and loved ones have died and they’re stressed because they’re continually worried about death but at the same time, with heroin or fentanyl, the withdrawal is so excruciating that they’re driven to use that next dose to alleviate the withdrawal, knowing at all times that they might die ... it’s horrific, that existence.”
Sutherland said substitution treatment decreases patients’ risk of overdose death, HIV and crime and helps them maintain stable housing. Some patients eventually reconnect with their families, find work and leave their drug use behind.
“It saves the system so much money to treat addiction well,” Sutherland said. “No one should die of opioid overdose. It’s a preventable death.”
Sarah Foster, a clinic and outreach nurse with PHS, said drug users are surprised to see the team working out of its tent, helping people begin substitution therapy in the open.
“For some people, it’s just to feel better that day but it’s building those relationships and letting them know about services that exist, because maybe they don’t know that we have a walk-in clinic that they can come to,” she said.
Foster said the vast majority of visitors are new to PHS but they’re coming back for follow-up treatment and engaging in their own care. Many of them get wounds treated and receive naloxone training and kits on the spot.
“It’s people that were sort of flying under the radar and really unattached,” Foster said. “I think it makes them feel more comfortable when they see us in our little leaky tent in the alley. It’s like, ‘Oh, you guys kind of get it.’”
At a press conference Friday, during which Vancouver officials called on the province to increase addiction-treatment funding, Dr. Mark Tyndall, executive medical director at the B.C. Centre for Disease Control, said “there is a real urgency” to expand access to low-barrier substitution therapy.
Tyndall said a clinic will open in January in the Downtown Eastside to serve this purpose — however, a long-term treatment strategy is needed.
“Some of the people that are currently overdosing and dying are on substitution therapy so it requires more than just simply getting people on methadone or Suboxone, obviously,” he said. “I think the longterm program for people needs to be set up.”