Eleven patients who were permitted to take home doses of medical-grade heroin from a Vancouver clinic have had the permission abruptly revoked.
The patients were told last week that they can continue ingesting the drug (diacetylmorphine) under medical supervision at the Providence Crosstown Clinic, but would no longer be able to carry a daily supply off-site, according to four patients who spoke with The Globe and Mail. They were cut off from receiving take-home doses – called “carries” – by weeks’ end and were not given a reason for the discontinuation.
The College of Pharmacists of British Columbia has an open investigation involving the clinic, but “it is not related to carries or diacetylmorphine and is only focused on recordkeeping,” spokeswoman Gillian Vrooman said in an e-mail. “We have not told the Crosstown Clinic to stop delivering any service.”
B.C.’s Ministry of Health said it is working with the college, the Ministry of Mental Health and Addictions and Providence Health Care “to resolve these concerns as quickly as possible.” Providence Health Care is a health care provider that oversees the clinic.
“Crosstown patients are able to continue receiving their doses at the clinic; however, we recognize the value for patients of being able to bring their doses home, as deemed clinically appropriate by a prescriber,” the ministry said in a statement.
Scott MacDonald, physician lead for the clinic, did not respond to an interview request.
Injectable, medical-grade heroin is considered a last-resort treatment for people with opioid-use disorder who have not benefited from multiple attempts at more traditional treatments, such as methadone and Suboxone.
A three-year heroin study conducted in part at the clinic found that patients receiving pharmaceutical heroin experienced physical and mental-health improvements, and either stopped or reduced illicit drug use and criminal activity. Employment and social reintegration also improved.
In recent years, as B.C. cautiously opens the door to providing pharmaceutical alternatives to a volatile illicit drug supply that has killed thousands, there have been calls to include medical-grade heroin in those discussions.
At Crosstown, patients typically come in two or three times a day, at set times, to inject under medical supervision. During the COVID-19 pandemic – spurred by physical distancing and isolation requirements – staff began delivering syringes to some patients. By July, about a dozen patients were permitted to visit the clinic for the first of their daily doses of heroin and take the remaining one or two doses home, in a North American first.
In an interview earlier this month, Dr. MacDonald said that while it was recognized for some time that some patients wanted more flexibility in treatment to work jobs and care for families, concerns about something going wrong kept the program under a supervised model until the pandemic spurred a change.
“COVID forced a loosening of regulations to allow more carries and risk-mitigation prescribing. There was no increase in mortality, and people reported satisfaction with more flexible dosing options,” Dr. MacDonald said.
“With that, we were able to show that this doesn’t have to strictly be in a medical setting, that it is safe and possible to provide care outside of the clinic.”
Before receiving carries, Crosstown patient Donnie Cinnamon was going to the clinic three times a day, three hours apart, meaning he was tied to the clinic for half a day. He said being able to take his medication with him for the past few months allowed him to start working again, picking up shifts staffing the front desk at a supportive-housing building. In an interview on Sunday, he said he would no longer be able to continue those shifts.
“A lot of us were going back to work,” he said. “This is slowing us down because we don’t know what’s going to happen in the next little while.”
Coral Watson works 40 hours a week at a supportive-housing building in Vancouver and said that no longer being able to take her second dose with her will mean an extra 90 minutes each day going to and from the clinic.
“I feel like cattle, having to go there every day,” she said. “I’m grateful for this program – I believe I would probably be dead without it – but it’s frustrating when you’re trying to get your life together, still having this ball and chain.”
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