A renowned HIV/AIDS clinic in Vancouver that helped pave the way in harm reduction by first offering supervised-injection service 14 years ago now wants to treat opioid addiction with injectable drugs.
Maxine Davis, executive director of the Dr. Peter AIDS Foundation, submitted a proposal to the Ministry of Health, Vancouver Coastal Health and Providence Health Care in March to offer injectable opioid-assisted treatment at its facility in Vancouver's downtown West End neighbourhood, according to documents obtained by The Globe and Mail under freedom-of-information legislation.
The Dr. Peter Centre already offers clients methadone and buprenorphine-naloxone (Suboxone), along with its small-scale supervised-injection service.
Ms. Davis wrote that the centre has felt the impact of British Columbia's worsening opioid crisis. Since mid-November, 14 clients of the centre's day-health program have died – none while at the centre – and opioids were to blame for half.
Non-fatal overdoses and drug-related illness have also increased.
"The Dr. Peter AIDS Foundation shares the collective sense of urgency to do more to save and stabilize lives – and to do so as quickly as possible," Ms. Davis wrote.
"Adding injectable opiates to our day-health program nursing care has the potential to expedite access to this urgently needed treatment and, with our experience and expertise providing complex care to this vulnerable population, to do so effectively."
Ms. Davis said the centre would be interested in hydromorphone and injectable pharmaceutical-grade heroin.
Hydromorphone is a licensed pain medication commonly used in palliative and acute care. A Vancouver study found it to be an effective substitution treatment for dependence on opioids such as a heroin without the regulatory hurdles and stigma of prescription heroin.
Providing a clean alternative steers people away from street drugs – which are often laced with illicit fentanyl and its analogues and continue to drive overdoses deaths – and engages drug users several times a day with the health-care system, proponents say.
The Crosstown Clinic, which conducted the hydromorphone study, is currently treating 22 people with the drug. Another organization, PHS Community Services Society, has offered it since last fall and is steadily expanding its program.
A recent donation of $500,000 to the Dr. Peter Centre would finance a necessary renovation and get the service started, Ms. Davis said. However, dedicated funding from the Ministry of Health provided through Vancouver Coastal Health would be needed to operate.
Ms. Davis said in an interview that the centre submitted a proposed budget based on more than 60 new clients joining the day-health program – a 40-per-cent increase. The clinic would expand hours, open on statutory holidays and ideally work in partnership with the Crosstown Clinic.
"We really, really want to do this," Ms. Davis said. "We think it's a perfect fit for what we do, to give people options for treatment." Ms. Davis said the proposal was "welcomed," but there has been no movement to date.
The B.C. Centre on Substance Use is still working on guidelines for expanding injectable therapies, and B.C.'s uncertain provincial government has not signalled it would dedicate funding for its expansion.
The Ministry of Health did not provide comment on the Dr. Peter Centre proposal specifically. However, it said in a statement that both Vancouver Coastal Health (VCH) and Fraser Health are "working on other options to expand access to hydromorphone treatment … in Vancouver and Surrey over the next few months."
Patricia Daly, chief medical health officer for VCH, said the health authority "will be expanding hydromorphone in a number of other clinics and locations over the next few weeks."
The Crosstown Clinic, which is undergoing renovations, is also expected to accept about 50 new patients by the end of the summer.