B.C. authority on substance use recommends retail heroin sales

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British Columbia’s authority on addictions care is recommending allowing regulated retail heroin sales in the province to stanch overdose deaths caused by fentanyl-tainted illicit drugs and to generate funds for addiction treatment services.

The BC Centre on Substance Use (BCCSU) laid out the proposal in a report released Thursday.

Evan Wood, executive director of the BCCSU, said local and international experts in criminology, economy and public health have long called for psychoactive substances to be regulated and controlled.

“But there hasn’t been a sort of thoughtful effort on what a regulated model might look like, and so we wanted to sit down with a group and say, ‘What might this look like?'" he said.

The report, titled Heroin Compassion Clubs: A Cooperative Model to Reduce Opioid Overdose Deaths and Disrupt Organized Crime’s Role in Fentanyl, Money Laundering and Housing Unaffordability, proposes a membership-based system inspired by the cannabis compassion clubs that emerged in B.C. in the 1980s and 1990s.

Members would be permitted to purchase personal amounts of the drug from a location connected to health care, peer support, free addiction treatment and referral to recovery services.

Revenue generated through this purchasing model would be redirected in-house to treatment and recovery services. A point of heroin (one-tenth of a gram) goes for $20 on the street; the same amount purchased legally through a supplier in Switzerland, for example, goes for $3.80. (A 2018 BCCSU drug-checking project found that 82.4 per cent of drugs sold as heroin on the streets of Vancouver didn’t contain any heroin at all, while 90.6 per cent tested positive for fentanyl.)

Details of membership eligibility are still to be determined, but the white paper recommends screening by a health care provider and mandatory training in overdose prevention, naloxone use and the various associated risks of heroin use.

Asked what would happen should a young person with little to no prior heroin use wants to sign up, BCCSU officials said there would be efforts made to dissuade him or her.

“We’ll talk to him enough to find out where he’s at and we’ll try to direct him to the right spot,” said Dean Wilson, a BCCSU peer engagement lead.

“We’re going to push kids like that away [from heroin use] while the drug dealers have great marketing and are trying to get the dope into kids’ hands."

The idea will require co-operation from all levels of government. In 2017, Ottawa made changes to the Food and Drug Regulations to allow for the bulk importation of drugs not currently marketed or available in Canada as needed in urgent health scenarios.

But while then-health minister Jane Philpott introduced the amendment with heroin in mind, it was designed specifically for substitution therapy as part of a treatment program and could therefore require changes to accommodate the compassion club sales model.

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A guidance document on the legislation states that “alternate approaches to the principles and practices described in this document may be acceptable provided they are supported by adequate justification.” But Health Canada declined to answer a specific question on this, responding with a general statement in support of evidence-based treatments, medication-assisted approaches and ongoing work.

When asked if she would support the BCCSU proposal, B.C. Minister of Mental Health and Addictions Judy Darcy said she had not yet read the full document.

“Any report or recommendation that comes to us that can save lives, of course we’re going to study carefully, but I’m not in a position to comment further on that right now,” Ms. Darcy said.

Vancouver Mayor Kennedy Stewart said he welcomes and supports “exploring innovative ideas like this one if they can save the lives of our family, friends and neighbours.”

The model has potential to reach a demographic at highest risk of fatally overdosing in B.C.: those who use alone, indoors. Allowing drug users to purchase a known substance from a location with peers and health services present provides a touch point to health care that might otherwise be missed.