Pubdate: Fri, 22 Jul 2016
Source: Globe and Mail (Canada)
Page: S1
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Andrea Woo

B.C. URGED TO PROVIDE PRESCRIPTION DRUGS AT SUPERVISED SITES

Health officials in British Columbia want to provide 
pharmaceutical-grade opioids to some addicts at 
supervised-consumption sites to tackle the province's soaring number 
of overdose deaths.

While they caution that there are no concrete plans yet, such a 
measure would make British Columbia the first province in Canada to 
provide prescription narcotics to addicts outside a clinical trial, 
while significantly expanding the role of facilities such as 
Vancouver's Insite - the country's first public supervised injection 
site, which has never offered drugs to users who inject there.

In a series of e-mails released under Freedom of Information 
legislation, the health officials note that deaths from illicit-drug 
overdoses are at an all-time high, driven in large part by the 
growing prevalence of illicit fentanyl, and more aggressive 
interventions are needed.

Brian Emerson, a medical consultant for British Columbia's Ministry 
of Health, said a case could be made for making pharmaceutical-grade 
opioids available to addicts through harm reduction sites.

"It is clear that people are going to use opioids irrespective of the 
risk, so giving them small quantities of something of known 
concentration through a service that can provide them with advice on 
safer use, and provide them with an overdose kit, is something worth 
consideration," Mr. Emerson wrote in a Feb. 25 e-mail to provincial 
health officer Perry Kendall, copying various officials from the 
ministry and the B.C. Centre for Disease Control.

Overdose deaths have spiked in British Columbia, reaching 371 in the 
first half of this year. British Columbia has long been seen as a 
leader in harm-reduction strategies - it is home to North America's 
only public supervised-injection site, and naloxone, an 
opioid-overdose-reversing drug, has been distributed free of charge 
to users throughout the province since 2012.

But health officials say more needs to be done to fight the scourge 
of fentanyl, which is now detected in about 60 per cent of 
illicit-drug overdose deaths.

Under the proposed idea, addicts who do not respond to traditional 
opioid substitution therapies such as methadone and Suboxone could 
receive a drug such as hydromorphone - a powerful painkiller - as a 
safer alternative to street heroin. It would be ingested in a medical 
setting, necessitating daily interactions with health-care providers. 
According to studies from Switzerland and Britain, this demographic 
makes up less than 10 per cent of all people on opioid-dependence therapies.

In an interview, Dr. Kendall said the idea - still "highly 
theoretical at present, with no moves to implement" - would be a 
second-line treatment for a small group of people.

"I think people are saying, in the face of all these overdoses, can 
we think about it as being something that is not desirable, but 
better than killing yourself with an illegal drug?"

But there are hurdles. Hydromorphone is commonly used in palliative 
and acute care, but it is not licensed for addiction treatment. 
Doctors can prescribe it for this purpose "off-label," but some may 
be hesitant to do that.

Similarly, the drug is not covered by British Columbia's PharmaCare 
as an addiction treatment.

To make hydromorphone an approved addiction treatment, its 
manufacturer would have to file a submission to Health Canada for 
review and approval. The federal department has not received such a 
submission to date.

A recent study out of Vancouver's Downtown Eastside, called SALOME, 
found that hydromorphone is an effective maintenance tool in treating 
a chronic heroin addiction.

Participants could not discern whether they were receiving heroin or 
hydromorphone, suggesting street heroin - stigma-laden and often cut 
with other substances - could be replaced with the licensed pain medication.

"There is a lot of focus on the supervised-consumption facilities, 
and that is very important, but that doesn't resolve the issue that 
people continue using illicit opioids," Eugenia Oviedo-Joekes, the 
study's lead researcher, said in an interview.

"What [this initiative] could mean is that, for those people who are 
not attracted to [traditional] treatment, they are unlikely to 
overdose because we are prescribing them pharmaceutical-grade 
injectable-opioids and re-engaging them into treatment. They might 
never have an overdose," she said.

Dozens of former study participants continue to receive 
pharmaceutical-grade heroin; Dr. Kendall said it is unlikely that 
prescription heroin would be considered for the initiative due to 
regulatory hurdles and the stigma that is attached to it.

Mark Tyndall, executive medical director for the B.C. Centre for 
Disease Control, supported the idea to provide some access to 
pharmaceutical-grade opioids, responding in an e-mail that some 
physicians are already doing it, but "it is certainly frowned upon 
and few patients can take advantage of this."
- ---
MAP posted-by: Jay Bergstrom