B.C. to offer Canada’s first safe drug supply in response to overdose crisis

The initiative will start by offering opioid replacements, including fentanyl patches. Stimulants will come later. Prescribed heroin is not included in the program, because of a lack of supply, the minister says.

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B.C. will be the first province in Canada to introduce a safe drug supply, in response to the deadly overdose crisis.

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But the rollout will begin slowly, at pre-existing clinics that already offer pharmaceutical replacement drugs as part of a trial program, and will at first offer just opioid replacement options, including fentanyl patches.

The initiative won’t offer stimulants or prescribed heroin in the first phase — which critics say is moving too slowly when an average of five British Columbians a day are being fatally poisoned by toxic street drugs right now.

Officials with the Ministry of Mental Health and Addictions, though, argue they are moving as fast as they can with Canada’s first safe supply program.

“I don’t want people to lose hope and feel that they’re not going to get access,” Minister Sheila Malcolmson told Postmedia today.

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“Absolutely, we feel the urgency of the public health emergency. There’s no one else in Canada that has taken this step. So British Columbia is continuing to break new ground building on that addition of prescribed safer supply over a year ago.”

At the beginning of the COVID-19 pandemic, which exacerbated the existing overdose crisis, the B.C. government created a temporary safe supply program, allowing doctors and nurses to prescribe medication alternatives to substances, including opioids, alcohol, stimulants and benzodiazepines.

Now, $22 million has been earmarked over the next three years for the five health authorities to make this safe supply a permanent option, starting with opioids. Fentanyl patches were offered in a limited trial project, and that will now be significantly expanded.

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“Nowhere else in Canada can anybody be prescribed a fentanyl patch for this purpose, so that really is a breakthrough, and based on input that we heard strongly through our consultations (with drug users),” Malcolmson said.

The government’s announcement said the first phase of the initiative would take 18 to 24 months, and be continued and expanded in health authority programs that already prescribe alternatives to illicit drugs. However, many of those clinics are urban and at capacity, so the question remains how the province will extend these services to rural and remote areas of the province.

Malcolmson said the five health authorities must report back to government in the next two weeks with their implementation plans, and more details will be known then; but she said “we think that it might take three to six months for actual things on the ground for the patient” to begin.

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Malcolmson also said she “recognizes there is a need” to include replacements for stimulants — the most common street drugs that fall into this category are cocaine and amphetamines — in the program, but she had no timeline for when that would happen.

“What medications are available are going to vary regionally based on the program and the service setting and the prescriber. And I guess that’s probably the bottom line: that other medications will be considered by each prescribing program and based on the needs of people in the program,” Malcolmson added.

She said drug users have also asked for prescription heroin, but said that is not being included at this time because the government has not been able to find a domestic supply. She had no timeline on its inclusion, but said the government would continue to look for a supply.

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Vince Tao, a community organizer with the Vancouver Area Network of Drug Users (VANDU), said: “This step is a decent one. But it is, as always, too little, too late.”

It’s an issue, Tao said, that “the power still rests in the hands of individual prescribers,” because that arrangement can be an “obstacle to access.”

VANDU members have reported that while some physicians, nurses and pharmacists are sympathetic to their needs, many health-care professionals are not comfortable prescribing these kinds of drugs, Tao said.

Tao said it seems unusual that the policy includes fentanyl patches, injectable hydromorphone and tablet hydromorphone, but not heroin, which has been prescribed in a limited capacity in B.C. for years.

Researchers from Providence Health Care and the University of B.C. led North America’s first clinical trial of prescribed heroin back in 2005.

More than 7,000 British Columbians have been poisoned by the toxic drug supply since the overdose public health crisis was declared in 2016.

Doctors and nurse practitioners will prescribe the safe supply, but the $22 million will fund other “wraparound services” to further help drug users, the government says.

lculbert@postmedia.com

More to come …

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