B.C. should give clean drugs to users, health officials urge
Top health officials in B.C. are discussing a plan to prescribe clean heroin or other opioids to people with addictions in an attempt to stem the rising death toll caused by street drugs tainted with fentanyl.
B.C.’s chief medical officer, Dr. Perry Kendall, said Thursday he supports a provincewide program in which those suffering from addiction, who are at a high risk and can’t be treated with conventional means, are given clean medical heroin or synthetic morphine and a safe place to inject.
Kendall said he envisions a network of trained addictions physicians and usage sites.
“Each health authority would have several places where an addiction expert was able to address and triage these people, and in a clinic where maybe it was attached to a supervised consumption site,” he said. “Those folks would be able to receive the oversight they’d need for the injections and get their prescriptions filled there. And then when those folks become more stabilized, maybe you can transition them to an oral medication, and then they might be somebody that a general practitioner could manage more easily.”
There are several European countries that treat opioid addiction with prescribed heroin. But the only B.C. program currently available is the Crosstown Clinic in Vancouver’s Gastown neighbourhood, a small facility that has reported success in helping save the hardest-to-treat people with addictions.
“We’ve been slow to expand that model,” said Dr. Patricia Daly, Vancouver Coastal Health’s chief medical health officer, who is also pitching the plan.
“We need to expand it rapidly. The ministry is very interested in this, and we’re having discussions among the public health experts in the province about how we can expand this.”
Health officials hope an expanded program could curb the seemingly unstoppable amount of fentanyl overdoses in B.C. through substitution injection treatment — bringing users into a clinic, prescribing them injectable opioids, eliminating their risk of contaminated drugs, and supervising their health care as they wean onto less lethal substances and into recovery.
Kendall and Daly said swift action is needed. New figures released this week show the number of fatal overdoses is not decreasing despite efforts to make drugs like naloxone, a fentanyl antidote, more accessible.
“We need to prevent people dying right now,” Daly said. “We’ve had 914 people die in 2016. There’s no end in sight. We’ve done what we can with making naloxone available. We’re expanding overdose prevention sites. But really, the ultimate cause of this crisis is people injecting these illicit drugs. We need to get past the stigma associated with this and recognize we have to replace it with a legal option.”
Daly said the federal government should immediately decriminalize all illicit drugs so people no longer have to use alone in fear, where there’s no help if they overdose.
Health Minister Terry Lake announced Wednesday that the province was making oral addiction treatment drugs methadone and Suboxone free for people with low incomes. But those treatments don’t work for all drug users: Some don’t respond to the oral drugs or relapse, and are better treated through a system that stabilizes them first with clean injectable opioids, Daly said.
Kendall acknowledged the idea of prescribing heroin to drug users might concern the public. He said it could make more sense to focus on hydromorphone — the legal morphine already used as a painkiller under the name Dilaudid — which is more widely available, cheaper and shown in local studies to be as effective as heroin in substitution treatment.
Yet hydromorphone isn’t recognized in Canada as a treatment for opioid addiction, raising concern that doctors won’t prescribe it. B.C. is still trying to find a solution with the College of Physicians and Surgeons, Kendall said.
“We’ve had some discussions with the college,” Kendall said. “In fact, Dr. Evan Wood in the B.C. Centre on Substance Use is drafting guidelines for opioid prescription, which would need to be run past the college and need to be approved by a number of addictions physicians and others in B.C.
“It’s a process in terms of clinical guidelines that is already happening, and hopefully we can move on it sooner rather than later.”
The push for clean drugs would require political buy-in from the B.C. Liberal government four months before an election. It would also have to surmount a cynical public that fears easier access to opioids will create more drug users.
“I acknowledge people are worried this is just going to make the problem worse,” Daly said. “We have data from other initiatives, including Insite, where there was no evidence of increased use.”
The government has been slow to respond to the overdose crisis, and should listen to the public health officers, NDP critic Selina Robinson said.
“If we are going to save lives, this is what we will have to do,” she said. “People are going to use and are going to use whatever they can find. And if they have access to clean drugs, then that’s better for them.”