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British Columbia B.C.’s new protocols for opioid abuse treatment garner some criticism

Naloxone is used to reverse the effects of an opioid overdose.

DARRYL DYCK/The Globe and Mail

Drug users and harm-reduction advocates are calling British Columbia's revamping of its clinical guidelines for treating opioid dependency a missed opportunity to expand heroin-assisted treatment – a controversial option has garnered support from the federal government amid the province's worst overdose crisis on record.

The release of the province's new guidelines on Tuesday – which take effect in June – came at the same time that health officials in Alberta announced a 25-per-cent increase in fentanyl-related deaths over the past year. New figures show that a record 343 people died of fentanyl-related overdoses in 2016, compared with 257 in 2015. (Alberta's total illicit-drug overdoses for 2016 are not yet available.)

"Opioid overdoses and deaths are a public-health crisis in Alberta," said Alberta associate Health Minister Brandy Payne. "Everyone in this room knows the devastating impact fentanyl and other opioids are having on families and communities."

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B.C.'s new guidelines, created by the recently formed B.C. Centre on Substance Use (BCCSU), place an emphasis on providing a broad range of options tailored to individual needs. The comprehensive document will replace existing guidelines by the College of Physicians and Surgeons of B.C. on prescribing the opioid-replacement therapies methadone and Suboxone – the trade name for buprenorphine-naloxone – in June.

While the guidelines include a new tool – slow-release oral morphine – to the existing treatment options, some say they missed the opportunity to widen the availability of Supervised Injectable Opioid Assisted Treatment (siOAT).

This type of therapy is suitable for only about 5 per cent of all people on opioid-assisted treatments, but these patients are the most vulnerable – and incur the largest societal costs.

One person using illicit opioids costs society an estimated $48,000 a year, compared with about $25,000 on siOAT, according to Providence Health Care, a B.C. non-profit organization.

A handful of drug users who attended the media event in Vancouver expressed frustration and anger that the evidence-supported option is still strictly limited to about 100 people.

John Pinkney, a drug user of 30 years, said his life turned around after he was put on heroin-assisted treatment as part of the Vancouver-based SALOME study five years ago. He stopped committing petty crimes to feed his addiction, went back to school for mental-health and addictions-related studies and made a commitment to his wife that they would "leave the street life behind."

Evan Wood, who on Tuesday was officially named director of the BCCSU, said the centre is actively working on offering siOAT, but that it is "more challenging than it sounds." Hurdles include the difficulty of importing pharmaceutical-grade heroin – it is not available in North America – and the question of where such operations can run.

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The BCCSU is also working to produce more robust local evidence on the treatments, which differ slightly from the numerous studies based on European models.

Federal Health Minister Jane Phipott supports siOAT. In September, she overturned a ban imposed by the previous Conservative government on physicians prescribing heroin. Last month, she wrote to provincial and territorial health ministers noting that clinical evidence supports unconventional treatments such as pharmaceutical heroin, and noted that Health Canada's chief medical adviser is available to "to further explore with your officials what they anticipate the needs are and any potential obstacles to accessing needed treatments."

A coroner's inquest last month also recommended the expansion of the program.

Meanwhile in Alberta, with the New Democrats facing calls from opposition parties, citizens groups and doctors to wage a more vigorous campaign against the growing public health crisis, Ms. Payne said that police and firefighters will now be able to provide an injectable form of the antidote naloxone.

As well, Alberta will now release fatality data every six weeks, as opposed its current quarterly batches. (B.C. releases monthly updates on the crisis.)

Rachel Notley's NDP has faced criticism for its muted response to the crisis as the government has refused to declare a public-health emergency and resisted calls to provide more timely information. The province's Health Minister has also distanced herself from the fentanyl crisis and passed the portfolio down to Ms. Payne, who was appointed to the new position of associate health minister a year ago.

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