The chief medical health officer of Vancouver Coastal Health is calling for the urgent regulation of illicit drugs, so substances could be sold or provided for free to those at high risk of overdose through a framework similar to policies on marijuana, alcohol and tobacco.
Dr. Patricia Daly said limits on who could access the drugs, with penalties for anyone trying to sell them to minors, would be part of a proposed regime to prevent overdose deaths of people who are accessing street drugs often containing the deadly opioid fentanyl.
“We have the highest overdose death rate of any jurisdiction in Canada and we have also implemented more services to address the crisis than any jurisdiction, so we believe we’ve done all the things we can do apart from regulating the illegal drug supply,” she said on Friday as she released a report containing 21 recommendations on dealing with the overdose crisis.
Users of regulated illicit drugs would need to be assessed by a doctor to determine if they could overdose and to deter people who may want to experiment with drugs, Dr. Daly said, adding the Vancouver Coastal region is “cutting edge” with programs aimed at preventing fatal overdoses, such as naloxone-distribution programs and overdose-prevention sites.
A unique pilot project provides pharmaceutical-grade pills of the opioid hydromorphone to users who ingest them or crush them to inject under supervision as a substitute for heroin after failing other forms of treatment.
“This is the first pilot of a regulated supply and that’s being funded by our provincial government,” she said. “I think we will see the federal government funding other pilots as we’re making progress with all levels of government.”
Dr. Christy Sutherland, who runs the “very successful” program, said about 60 people are currently using hydromorphone.
“There are no plans for it to end. We are working on ongoing expansion,” she said.
Vancouver Coastal Health will be applying to conduct more pilots on a safer drug supply after a call for proposals by the federal government last month, Dr. Daly said.
She said decriminalization of possession of drugs for personal use is also a priority, but Prime Minister Justin Trudeau has maintained the government is not prepared to take that step.
The Vancouver Police Department has long been supportive of a regulated drug supply and instead of arresting drug users refers them to outreach teams and treatment, and the fire department will soon be working with Vancouver Coastal to do the same, Dr. Daly said.
She said an unregulated drug supply would be recognizing the fact, as police have, that illicit drug use is not a crime, but a health issue that needs to be addressed through innovative approaches because fentanyl is almost always present when drugs are tested for contamination.
Dr. Daly’s report says the opioid is 50 times stronger than heroin and was detected in 87 per cent of overdose deaths in the region in 2018, up from 25 per cent in 2015.
Expanding treatment for people battling addiction to opioids isn’t enough to eliminate the risk of death, especially for drug users who have not connected with the health-care system, she said.
While residents of the Downtown Eastside are also experiencing the highest rate of fatal overdoses in Vancouver, smaller rural communities such as Powell River and the Sunshine Coast are also disproportionately affected by the epidemic, Dr. Daly said.
In April, federal Health Minister Ginette Petitpas Taylor added diacetylmorphine, or pharmaceutical-grade heroin, to the federal government’s list of drugs that can be accessed for an urgent public-health need. The designation means any province or territory can import the drug, which was first used at the Crosstown Clinic in Vancouver for people who had tried other ways to treat their addiction.
Don MacPherson, executive director of the Canadian Drug Policy Coalition, said neither hydromorphone nor pharmaceutical-grade heroin, which isn’t produced in Canada and must be imported from Switzerland, can be scaled up fast enough to meet current demand so regulating illegal drugs would the most effective approach to fighting the overdose epidemic.
“We’ve left these other classes of drugs for criminals to regulate, and they seem to be employing a free-market model and making them available in every city in North America,” Mr. MacPherson said.
Health Canada said in June that data reported as of May indicated there were 11,577 apparent opioid-realted deaths in Canada between January, 2016, and December, 2018, and most of the fatalities occurred in Western Canada.
The department said 73 per cent of the deaths in 2018 involved fentanyl, and that about 75 per cent of the deaths also involved one or more types of non-opioid substances.
Fentanyl was involved in 88 per cent of the deaths in both British Columbia and Alberta in 2018, but 100 per cent of the fatalities in Yukon involved that opioid, up from 80 per cent two years earlier, the data say.