Vancouver program offers drug users at-home detox treatment

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Vancouver Coastal Health has launched an at-home detoxification program in hopes of reaching drug addicts and alcoholics who want to get clean but are reluctant, or otherwise unable, to attend residential treatment facilities.

The two-week program, called the Substance Use Treatment and Response Team, or START, is the latest effort to combat a soaring number of overdose deaths in the region. Vancouver Coastal Health officials say it is not targeted at any specific group but would be ideal for those who are turned off by residential detox because of the associated stigma.

START nurses would visit a client two times a day for the first five days and provide pharmacological treatments for withdrawal management – such as Suboxone for an opioid addiction or a benzodiazepine for an alcohol addiction – and other supports.

The remaining days would be spent connecting the client to appropriate services moving forward, such as counselling and other psychosocial interventions. This part is crucial, as risk of overdose is higher after a person has gone through a detox process.

John Alvarez de Lorenzana, the lead physician for the program, said doctors and nurses will work with clients to develop individual detox plans. "A lot will depend on what substance a person is coming to us for, and what the goal is for them and for us," he said.

The VCH says it will contact interested clients within two hours of receiving a referral from a health-care provider, so it can capture them the moment they want to get help.

There are limitations to the program. Clients must be 19 years of age or older, reside in Vancouver, and be in good enough physical and mental condition so that an at-home program is appropriate.

As well, clients must reside in a safe, stable and substance-free environment, which would appear to preclude those who live on the street, as well as those in temporary or low-barrier shelters. Dr. Alvarez de Lorenzana said if such an applicant was otherwise suitable, he or she could potentially stay at a VCH facility for the duration of the program – though this would no longer constitute an "at-home" detox program.

Applicants must also have a support person available 24 hours a day throughout the withdrawal process.

"We've avoided having people like husband and wife who are both using be each other's support person, for obvious reasons," Dr. Alvarez de Lorenzana said. "But if we can't find someone that they can use as a support person, then we will try to work around that." A potential solution would be, again, to have the client stay at a VCH facility with a staff member as the support person, he said.

Opioid users and their support people will be given naloxone, a drug that reverses symptoms of an opioid overdose, and trained in how to use it.

The START program, which began accepting clients in June, currently has a capacity of eight clients at a time but will likely grow, Dr. Alvarez de Lorenzana said. It's expected to help more than 400 people a year, according to the VCH.

Laura Shaver, president of the Vancouver Area Network of Drug Users, said the program seems best suited for the "shirts and skirts instead of the rips and tears," meaning working-class drug users rather than entrenched addicts typically associated with the city's Downtown Eastside.

"We know that pretty much anybody who is on disability, or welfare, can't afford to live any place other than one of the SROs in the Downtown Eastside that is riddled with drug use," she said. "The support person would probably also need to have a phone, which would cut out even more people."

B.C. health officials have made efforts to reach a broad range of drug users in light of a growing number of drug overdose deaths owing largely to illicit fentanyl. This includes a push for more supervised consumption sites, public awareness campaigns in bars and restaurants, and a testing service, still being developed, to help users identify if their drugs have been adulterated.