Pubdate: Sun, 18 Dec 2016
Source: Province, The (CN BC)
Copyright: 2016 Postmedia Network Inc.
Contact:  http://www.theprovince.com/
Details: http://www.mapinc.org/media/476
Author: Nick Eagland
Page: 3

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 drugusers 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
long-term program for people needs to be set up."
- ---
MAP posted-by: Matt