Vancouver will begin offering pharmaceutical-grade pills to opioid drug users in the latest attempt to prevent deaths in a city that experiences one lethal overdose every day.
A pilot project set to launch from Vancouver’s largest social-service provider will allow about 50 patients at a time to access the opioid hydromorphone in tablet form and ingest them on site while staff observe them. This offers a safer alternative to an illicit drug supply tainted by deadly fentanyl.
At least 1,380 people died of illicit drug overdoses in British Columbia from January to November of this year, with fentanyl detected in about 84 per cent of deaths.
The PHS Community Services Society program, to launch Jan. 8 at the Molson Overdose Prevention Site in Vancouver’s Downtown Eastside, is an expansion of an injectable opioid program available on a relatively small scale at four PHS sites and at the Crosstown Clinic in Vancouver. (Surrey also has an injectable hydromorphone program.)
A separate program also expected to roll out early in the new year intended to provide more open access to opioid drug users will allow people to take hydromorphone pills with them.
Hydromorphone is an opioid medication used to treat moderate to severe pain that is commonly used in palliative and acute care. One Vancouver study found people who use heroin could not differentiate between the two, suggesting hydromorphone could be an affordable and effective substitution therapy.
PHS medical director Christy Sutherland said the idea to dispense the drug in pill form came from patients themselves, who were not satisfied with the injectable program.
“When I chat with them about it, they will say they don’t think it’s as effective as the tablets – that when they were using tablets on the street, they actually felt better,” Dr. Sutherland said.
“And so for patients who have been unable to stabilize on the traditional injectable program with the liquid hydromorphone, we thought we needed another option with them.”
Dr. Christy Sutherland at the Portland Hotel Society Health Clinic, Aug. 28, 2018.
Since September, 2016, Dr. Sutherland has started more than 300 people on injectable hydromorphone. It operates at three PHS housing sites and at the Molson OPS, and there are 50 to 60 people on it at one time.
Meanwhile, the Crosstown Clinic – the only one in North America to offer prescription diacetylmorphine (heroin) – has roughly 100 patients at any given time on either heroin or injectable hydromorphone. As of this week, there are 104 patients on diacetylmorphine and 16 on hydromorphone.
“It’s so nice to be able to provide people with choices for when they’re deciding what they need for treatment for their opiate-use disorder,” Dr. Sutherland said. Methadone was the only available option not too long ago, she added, and while it is effective for many people with opioid-use disorder, it is not right for everyone.
Also expected in the new year is the rollout of a hydromorphone pilot project led by Mark Tyndall, executive director of the BC Centre for Disease Control (BCCDC). Unlike the PHS program, which requires ingestion to be witnessed by staff, this program will dispense pills for drug users to take with them.
Dr. Tyndall describes the BCCDC project as having a less restrictive, less medicalized approach that will hopefully appeal to those who will not use their drugs in a clinical setting.
“We’re supposed to be meeting people where they’re at, and we’re actually meeting regulators where they’re at,” he said. “We’re trying to work within a structure that’s just not flexible enough to allow people access to these drugs.”
Dr. Tyndall is still in the process of securing ATM-style machines – with biometric scanners, real-time monitoring and alarm systems – that would distribute the pills to patients. The goal is to roll out the program with staff distributing the pills early in the new year and then transitioning to machine distribution a few months later.
Vancouver Mayor Kennedy Stewart’s overdose emergency task force this month issued its first recommendations on the overdose crisis, which included securing a storefront space for the BCCDC project by April, 2019, at the latest.
Dr. Tyndall has said before that his low-barrier initiative is not a clinical response, but a public-health response amid an unprecedented crisis. An illicit supply supplanted by the powerful opioid fentanyl has caused overdose deaths to surge across North America over the past five years.
Injectable therapy requires a patient to visit a clinic two or three times a day to inject under supervision, does not allow for take-home doses and can cost up to $25,000 a person every year.
In comparison, an eight-milligram hydromorphone pill costs 32 cents – or $700 for two pills, three times a day for a year.
Andrea Woo