Pubdate: Thu, 28 Dec 2017
Source: Georgia Straight, The (CN BC)
Copyright: 2017 The Georgia Straight
Author: Travis Lupick
Page: 6


Vancouver has a history pioneering harm-reduction programs. In 2003,
it opened North America's first supervised-injection facility, Insite.
In 2014, it moved a prescription-heroin program beyond the confines of
an academic study.

Now B.C. will launch its most radical drug program yet. It's a plan
that one of the province's top doctors says could be a partial
solution to the province's opioid crisis.

Tentatively scheduled to begin in March 2018, Vancouver will dispense
hydromorphone-a synthetic opioid similar to heroin-in a way that, if
all goes according to plan, will not require a doctor's visit and
possibly not even a prescription for the powerful drug.

In a telephone interview, Dr. Mark Tyndall said the program's primary
goal is not to address addictions but to reduce overdose deaths.

"We'll put our concerns with fixing addiction on the back burner right
now while we deal with this crisis," the executive director of the
B.C. Centre for Disease Control told the Straight.

"This is a public-health response, not an addiction-medicine
response," Tyndall continued. "People need access to safer drugs."

B.C. is on track for more than 1,400 illicit-drug overdose deaths in
2017. That compares to an average of 204 deaths per year from 2001 to
2010. In 2017, fentanyl and fentanyl analogues have been detected in
more than 80 percent of drug-overdose deaths in B.C.

Searching for answers, Tyndall submitted a proposal to Health Canada's
substance-use-and-addictions program to remove the risk posed by
fentanyl. He outlined how B.C. could give people access to a regulated
supply of opioids distributed by the government and its partners in
health care and social services.

Health Canada approved the application and is providing $1 million to
run the program for three years. Tyndall emphasized that the details
are still being worked out but said the proposal describes three
options for distribution. All three create scenarios in which someone
addicted to opioids would no longer have to purchase unknown
substances on the street but would instead obtain pure and regulated
opioids of an exact and known dose.

Hydromorphone pills (sold under the brand name Dilaudid) could be
dispensed inside social-housing projects where nonmedical staff
already provide residents with methadone and Suboxone (traditional
medications for the management of an opioid addiction).

The proposal also suggested a pilot project could see hydromorphone
available at certain supervisedinjection facilities, such as Insite.

The third option is for select storefront pharmacies to provide access
to hydromorphone pills, again similar to how they already provide
methadone and Suboxone to registered patients.

Regarding who will qualify to receive hydromorphone as a substitute
for street drugs, Tyndall described a group that could be quite large.

"People who are at risk of overdosing and who have an opioid
dependency," he said.

In this respect, the program could differ significantly from
Vancouver's prescription-heroin program, which operates out of a
Downtown Eastside clinic called Crosstown.

Crosstown's prescription-heroin program was designed to stabilize the
life of a person who's been severely addicted to opioids for many
years. For Tyndall's hydromorphone patients, the bar could be set
significantly lower.

Another key area where the two programs differ is money.

The average Crosstown patient costs B.C. $27,000 a year. That's
because diacetylmorphine-the medical term for heroin-must be imported
from Europe. As well, dispensing the drug requires a full-time staff
consisting of both doctors and nurses and a stand-alone building with
stringent security requirements specific to diacetylmorphine.

Meanwhile, the cost of an eight-milligram Dilaudid pill obtained via
B.C.'S Pharmacare program is just 32 cents. If a patient is given
three pills three times a day, the cost of one patient's drugs works
out to about $700 annually. Then, because the distribution model
Tyndall envisions integrates the program into existing social
services, and because it may not require the involvement of doctors or
nurses, administration expenses will likely also be significantly
lower than those of prescription heroin.

"It [Crosstown] is not nearly addressing the scale of what we're up
against," Tyndall said. "The next step, to me, is that we get people
something that's cheap and scalable, which is hydromorphone pills."

Tyndall named two of Vancouver's largest nonprofit-housing providers
as possible partners.

The first is Lookout Housing + Health Society, with which he said
talks are progressing. He also mentioned the Portland Hotel Society
(PHS) as a potential "natural fit". (As the Straight reported last
June, PHS quietly launched a hydromorphone program of its own in
December 2016. It continues today but is different from what Tyndall
has proposed in that its primary focus is addictions management rather
than preventing overdose deaths.)

Tyndall acknowledged the will not be perfect.

"For some people with high tolerance, this might not be an option for
them, because we can probably only give out so many pills at a time,"
he said.
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