Pubdate: Sat, 23 Dec 2017
Source: Vancouver Sun (CN BC)
Copyright: 2017 Postmedia Network Inc.
Author: Camille Bains
Page: A14


Making a safe opioid available in vending machines may be the next
harm-reduction tool to fight the deadly overdose epidemic, says the
executive medical director of the B.C. Centre for Disease Control.

Dr. Mark Tyndall said he envisions a regulated system where drug users
would be assessed, registered and issued a card to use in vending
machines to obtain hydromorphone, a painkiller commonly marketed under
the brand name Dilaudid.

"I'm hoping that it's kind of like supervised injection sites," he
said of the program that could begin as early as next March. "At first
it sounded a bit off the wall and now it's pretty well accepted."

Funding to expand access to hydromorphone would first be used to
distribute pills through supportive housing units that also dispense
methadone and suboxone as well as through a nurse at
supervised-injection sites before they are sold through vending
machines, Tyndall said.

"People could pick these drugs up at supervised-injection sites, but
there's no reason you couldn't use vending machine technology to do
that. So people would show up, have their card, click it in and get a
couple of pills."

Hydromorphone pills dissolve well in water and Tyndall said he expects
most people will grind them up and inject them.

A small part of the funding will come from a three-year, $1-million
Health Canada grant that includes patients in Alberta, Tyndall said,
adding the machines could also be placed in other areas where drug use
is prevalent, as well as near health clinics in remote

"We don't have really anything to offer people who are dying around
the province in smaller communities, where sometimes they don't even
have a doctor who can prescribe methadone and certainly will never
have a supervised-injection site," Tyndall said.

"You'd have to ensure there's some security system because we don't
want people kicking these things in and stealing all the pills, and we
don't want situations where people are taking out big quantities and
selling them on the street."

Tyndall said while theft is a major concern of any opioid-distribution
system, anyone buying stolen hydromorphone pills would at least be
getting safe drugs instead of those that could be laced with the
powerful opioid fentanyl, which has been linked to hundreds of deaths
across Canada.

Safeguards would also include supplying two or three pills, up to
three times a day, to prevent users from being targeted by criminals,
Tyndall said.

"We've done some focus groups and most people feel they'd be quite
happy with two Dilaudids, eight milligrams, three times a day," he

However, people who are assessed as doing well could eventually obtain
a two-or three-day supply of pills, much like takehome methadone,
Tyndall added.

High-dose injectable hydromorphone is currently provided to chronic
substance users at a Vancouver clinic called Crosstown, the only such
facility that also dispenses diacetylmorphine, or medical-grade heroin
to patients who have repeatedly failed to kick an addiction to illicit
drugs after multiple drug-substitution programs.

"This is not an addiction medicine response," Tyndall said, adding new
approaches need to have an impact on the overdose epidemic. "We need
to make this is public health thing, much like vaccine programs."

The B.C. Coroners Service has reported that 1,208 people fatally
overdosed in British Columbia between January and October this year.
It said fentanyl was detected in 999 of the confirmed and suspected
deaths so far in 2017, an increase of 136 per cent from the same
period last year.
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