Pubdate: Fri, 04 Aug 2017
Source: Ottawa Sun (CN ON)
Copyright: 2017 Canoe Limited Partnership
Author: Elizabeth Payne
Page: 5


Managed opioid program to open in response to fentanyl crisis

As a fentanyl crisis sweeps the country, medical officials in Ottawa
are moving quickly and quietly to open a supervised injection site for
opioid users.

The opioid substitution program, which will be the only the second of
its kind in Canada, is expected to formally begin in September at the
Shepherds of Good Hope in the ByWard Market area.

While attention in this city has been focused on a recently approved
supervised-injection site for illegal drug users, officials with Inner
City Health have been planning the managed opioid program, which will
open first.

It will be somewhat similar to the supervised injection site to be run
out of the Sandy Hill Community Health Centre, where injection drug
users inject their own illegal drugs under supervision in a sterile

Under the managed opioid program, however, participants will be
prescribed hydromorphone, provided by Inner City Health, which they
will either inject or take orally several times a day under

Because the drugs involved are legal when prescribed, the program does
not require a special exemption, as supervised-injection sites for
illegal drugs do.

But Inner City Health has contacted both the College of Physicians and
Surgeons of Ontario and the Ontario College of Nurses about the plan
and for support.

Inner City Health, which provides health care to Ottawa's homeless,
has been thinking about introducing the program for some time, said
executive director Wendy Muckle, but the fentanyl crisis has made the
need urgent.

"We can't sit around and talk about this any longer. This is like you
are in a war zone, you've got to do what you've got to do," she said.


As she talked about the program Thursday morning, staff members from
Inner City Health were being dispatched with naloxone kits to check on
a large group of men shooting up on the sidewalk on Murray St., some
of them lying on the sidewalk beside a construction site, near the
Shepherd's of Good Hope.

This was the start of "cheque day," when government cheques are mailed

It's considered the worst day of the month for those working with
addicts because drug usage and overdoses spike and scenes such as the
Murray "shooting party" become more common.

Drug overdoses have ramped up dramatically in Ottawa since the
beginning of the year, said Muckle.

In June, the organization saw an average of an overdose a

In February, two of its longtime clients died from

Muckle said it became clear that the organization needed to change its

"We have done a lot, but, fundamentally, someone has to look at
changing the drug supply and the only way to change the drug supply is
to control it."


The goal of the managed opioid program is to prevent people from
seeking opioids on the street, where the drugs may be laced with
fentanyl and where they may encounter other dangers, in addition to
breaking the law.

Muckle said Inner City Health decided to move quickly after hearing
about opioid-replacement programs, and research supporting the use of
managed hydromorphone, at a conference in June.

She said the police are aware of the program.

"You can understand from the police perspective it is a

A ByWard market business owner asked Inner City Health to introduce
such a program to reduce the buying and selling of drugs in the Market.

Although opioids are legal, if prescribed, buying them on the street
is illegal and those selling them can be charged with


On Thursday, Inner City Health's Dr. Jeff Turnbull checked in on a
client of Inner City Health who is addicted to opioids and illegal

She is being given oral opioids in an attempt to get her off street
drugs, part of the early "ease into" the formal opioid-management program.

But she made it clear during a consultation that the drugs provided by
Inner City Health were not enough to stop her from topping up with
street drugs.

Doctor and patient talked about increasing her dosage.

"We are trying to get it so you are not on the street," Turnbull told

"I know, a lot of my friends have died. There is fentanyl on the


Though relatively rare in Canada, opioid substitution is already done
in Vancouver and has long been in place around the world, said Muckle.

In most places, heroin is given as a substitute.

She said Inner City Health did not want to use heroin, in part because
of the attention that would receive.

But she added that research has shown hydromorphone, sold under the
brand name Dilaudid, works just as well, and better in some cases.

She said the program is intrusive, by definition.

Every injection or medication clients take has to be observed and

As they stabilize, she said, the hope is that they will choose less
intrusive options, such as methadone.

"We want people to migrate to treatment that actually works for

She also said there should be no fear that people will be lined up
around the block for the free opioids.

"The program is not a free-for-all. It is a very restrictive


Meanwhile, Muckle said, opioids are "flowing freely" in the

Staff at Inner City Health check rooms and bathrooms at the shelters
every 15 minutes to make sure no one has overdosed.

"It is a full-court press. It just hit in February and it has been
crazy since."

In a statement, Ottawa Public Health said it supports the initiative.
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