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Dr. Christy Sutherland in Vancouver on April 7. Dr. Sutherland, PHS Community Services Society medical director, says her team developed fentanyl capsules with a national pharmaceutical supply chain and a local compounding pharmacy because she observed that patients could no longer be properly stabilized on traditional medications such as methadone and Suboxone.DARRYL DYCK/The Globe and Mail

A Vancouver social services organization has launched a program to sell pharmaceutical-grade fentanyl to drug users who would otherwise purchase toxic, illicit substances from street dealers, a first-in-Canada model that straddles prescription-based safer supply and regulated drug sales.

Under the PHS Community Services Society program, a person who would ordinarily buy illicit opioids – particularly dangerous because of their unknown potencies and additives – can instead purchase fentanyl powder capsules from one of the program’s clinical sites for the same price: $10 for a tenth of a gram, called a point. The first sale was Thursday.

British Columbia is approaching its sixth year of a public-health emergency declared in response to record-shattering drug deaths from an increasingly volatile drug supply. Meanwhile, the province has made little progress on a plan announced last summer to roll out safer drug programs across all health authorities.

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PHS medical director Christy Sutherland said her team developed the capsules with a national pharmaceutical supply chain and a local compounding pharmacy because she observed that patients could no longer be properly stabilized on traditional medications such as methadone and Suboxone. As well, she has lost count of the times she has knelt on the sidewalk outside her Downtown Eastside clinic, ventilating an overdose victim with a bag valve mask, knowing that the person did not have to overdose.

“It seems very strange to me as a family doctor that I’m co-ordinating a fentanyl sales program,” Dr. Sutherland said in an interview Thursday. “But then, how many overdoses do you need to do before this is the program that you launch? … The grief that we feel for the deaths of so many of our patients, and to think, ‘Oh my gosh, if only we had a time machine and could go back those 10 minutes and have given them a different drug.’”

The capsules consist of pure fentanyl that can be absorbed into the body, as well as buffers of dextrose (a type of sugar) and caffeine. The doses vary depending on each patient’s tolerance level.

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The first sale of fentanyl powder capsules from one of PHS Community Services Society’s clinical sites. Cashier’s name has been redacted.Handout

Prior to a patient beginning the program, Dr. Sutherland first reviews that person’s medical and prescription history, conducts a physical exam and administers a urine drug test. Once it is determined that the program is appropriate for that person, a nurse will facilitate a titration process, going through a standardized protocol of escalating doses until the dose replaces the person’s illicit drug supply over two to three days.

From that point, the patient can purchase as they normally would through the program’s clinical sites. The capsules can be opened, and the powder inside can be snorted, smoked or cooked to inject. Any increases after initial titration require another evaluation.

The program “uses the same framework as when I go to my doctor and I get my prescription for my Ventolin puffer and I go to Shoppers Drug Mart and I buy my prescription,” Dr. Sutherland said, referring to a medication used to treat breathing problems.

“To me, I’m replicating that for this patient population, for the drugs that they need – and they need these medications because of the systems in place, because of the war on drugs, and because organized crime controls the supply chain of fentanyl. This is an exit ramp from that.”

She said the price is intended to deter criminals from hijacking the system.

“Organized crime doesn’t go and purchase cases of wine to resell because we can all just buy wine at the liquor store, so there is no profit to be made in that way,” she said. “So I want my program to be similar in that it’s sold for what it would sell for on the street – $10 for a point – so there is no loophole for bad actors to come in and take advantage of the system.”

There is no requirement to be on other treatments, but all participants are connected to longitudinal primary care. Wound care, pap tests and blood pressure medications, for example, can all be accessed through the program, along with pathways to recovery.

The BC Centre on Substance Use is evaluating the program and is expected to issue preliminary findings later this year. Timing will depend on how quickly the program ramps up and how quickly the evaluation team is able to recruit research participants, according to the centre.

At least 2,232 people died of illicit drug toxicity in British Columbia in 2021, with illicit fentanyl detected in 83 per cent of those deaths, according to preliminary data.

Proponents of safe supply say it’s a way to curb the growing number of Canadians dying each year to a street drug supply saturated with dangerous substances such as fentanyl. Safe supply programs offer pharmaceutical alternatives and studies show they can prevent overdoses and other crime, while critics worry that recipients may sell their prescribed drugs to buy other substances.

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