Pubdate: Tue, 27 Jun 2017
Source: Globe and Mail (Canada)
Copyright: 2017 The Globe and Mail Company
Author: Andrea Woo
Page: S2


A renowned HIV/AIDS clinic in Vancouver that helped pave the way in
harm reduction by first offering supervised-injection service 14 years
ago now wants to treat opioid addiction with injectable drugs.

Maxine Davis, executive director of the Dr. Peter AIDS Foundation,
submitted a proposal to the Ministry of Health, Vancouver Coastal
Health and Providence Health Care in March to offer injectable
opioid-assisted treatment at its facility in Vancouver's downtown West
End neighbourhood, according to documents obtained by The Globe and
Mail under Freedom of Information legislation.

The Dr. Peter Centre already offers clients methadone and
buprenorphine-naloxone (Suboxone), along with its small-scale
supervised-injection service.

Ms. Davis wrote that the centre has felt the impact of British
Columbia's worsening opioid crisis. Since mid-November, 14 clients of
the centre's day-health program have died - none while at the centre -
and opioids were to blame for half.

Non-fatal overdoses and drug-related illness have also

"The Dr. Peter AIDS Foundation shares the collective sense of urgency
to do more to save and stabilize lives - and to do so as quickly as
possible," Ms. Davis wrote.

"Adding injectable opiates to our day-health program nursing care has
the potential to expedite access to this urgently needed treatment
and, with our experience and expertise providing complex care to this
vulnerable population, to do so effectively."

Ms. Davis said the centre would be interested in hydromorphone and
injectable pharmaceutical-grade heroin.

Hydromorphone is a licensed pain medication commonly used in
palliative and acute care. A Vancouver study found it to be an
effective substitution treatment for dependence on opioids such as a
heroin without the regulatory hurdles and stigma of prescription heroin.

Providing a clean alternative steers people away from street drugs -
which are often laced with fentanyl and its analogues and continue to
drive overdoses deaths - and engages drug users several times a day
with the health-care system, proponents say.

The Crosstown Clinic, which conducted the hydromorphone study, is
currently treating 22 people with the drug. Another organization, PHS
Community Services Society, has offered it since last fall and is
steadily expanding its program.

A recent donation of $500,000 to the Dr. Peter Centre would finance a
necessary renovation and get the service started, Ms. Davis said.
However, dedicated funding from the Ministry of Health provided
through Vancouver Coastal Health would be needed to operate.

Ms. Davis said in an interview that the centre submitted a proposed
budget based on more than 60 new clients joining the day health
program - a 40-per-cent increase. The clinic would expand hours, open
on statutory holidays and ideally work in partnership with the
Crosstown Clinic.

"We really, really want to do this," Ms. Davis said. "We think it's a
perfect fit for what we do, to give people options for treatment." Ms.
Davis said the proposal was "welcomed," but there has been no movement
to date.

The B.C. Centre on Substance Use is still working on guidelines for
expanding injectable therapies, and B.C.'s uncertain provincial
government has not signalled it would dedicate funding for its expansion.

The Ministry of Health did not provide comment on the Dr. Peter Centre
proposal specifically. However, it said in a statement that both
Vancouver Coastal Health (VCH) and Fraser Health are "working on other
options to expand access to hydromorphone treatment … in Vancouver and
Surrey over the next few months."

Patricia Daly, chief medical health officer for VCH, said the health
authority "will be expanding hydromorphone in a number of other
clinics and locations over the next few weeks."

The Crosstown Clinic, which is undergoing renovations, is also
expected to accept about 50 new patients by the end of the summer.
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