Ottawa has approved a pilot project that will allow health officials in B.C. to distribute clean opioids to drug users to use as they please, marking one of the province's most radical efforts to address a fentanyl-saturated drug supply that has killed more than 1,000 people this year.
Details are still being finalized, but Mark Tyndall, executive director of the BC Centre for Disease Control (BCCDC), said the idea is that people at high risk of overdose, once registered, will be able to pick up hydromorphone pills at either supportive housing units or supervised consumption facilities, two or three times a day, and self-administer them. Most would likely choose to crush, cook and inject them.
Participants would likely be required to consume the drug on-site initially, but after a short evaluation process be able to take home their doses – perhaps a day's worth at a time, Dr. Tyndall said.
The pilot will start with around 200 people in Vancouver and Victoria, but a primary goal is to scale it up as soon as possible.
Dr. Tyndall said he does not believe participants will give away or sell their dose, as they are opioid-dependent and need it for themselves. However, he noted that drug diversion wouldn't necessarily be a problem if it did occur.
"In the case that someone did divert their drugs, then at least the persons who received them would not be overdosing," he said. "Everyone must remember that it is very easy to buy drugs on the street right now so there is no way that diversion would make things worse."
This is different from supervised injectable opioid assisted treatment, an intensive treatment option currently available on a small scale to a limited amount of people in B.C., Ontario and soon Alberta. 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 per person per year.
In comparison, an 8-milligram hydromorphone pill costs 32 cents – or $700 for two pills three times a day, for a year.
Dr. Tyndall emphasized that this low-barrier initiative is not a clinical response, but a public-health response amid an unprecedented crisis. Its aim is not to treat addiction, but to stop overdose deaths due to toxic street drugs.
"We need a public health approach that really focuses on how we're going to bring overdose deaths down," he said.
"How we're going to treat and prevent addiction is a whole other problem, and we're not going to solve that in the next year. But I think we can solve the overdose epidemic in the next year."
The pilot is expected to begin in April and run for three years initially.
The idea was one of many floated last June at the BC Overdose Action Exchange, which brought together public-health leaders, policy makers and people with lived experience to identify new overdose prevention strategies. The BCCDC submitted a proposal to Health Canada's Substance Use and Addictions Program (SUAP), which recently approved it.
The SUAP, which provides about $26-million annually to fund innovative programs related to problematic substance use, will contribute $1-million toward the pilot. The program continues to review a "significant number of proposals," according to Health Canada.
The BCCDC will work with various community partners to develop operational and evaluation protocols. It is also in discussions with Alberta's opioid emergency response commission about a possible pilot in either Calgary or Edmonton.
On Monday, the Public Health Agency of Canada released new data that show Canada is on pace to lose more than 4,000 people to opioid-related overdoses this year.
In hard-hit B.C., more than 1,200 people died of illicit drug overdoses from January through October and fentanyl was a factor in about 1,000 of those deaths.