Patients on Vancouver’s Downtown Eastside will soon be able to access paid, prescription fentanyl that they can take home and use, an option the doctor leading the program says will allow people to escape “the violent system of trying to see your drug dealer and stay out of withdrawal every day.”
An initiative of PHS Community Services Society, the Expanded Access Program is an effort to expand access to a safe supply of drugs, as the number of deaths from the illicit, toxic supply continues unabated. A report from the BC Coroners Service released Tuesday said 174 people died in February of 2022 – which works out to more than six people dying each day, on average.
Medical director and family physician Dr. Christy Sutherland says the decision to prescribe fentanyl was a response to what people are currently using, and what substances they are currently getting in the illicit market.
“I can see over the years as the drug supply chain has changed, that we’re no longer able to meet the needs of our patients,” Sutherland said.
“I can see them on massive doses of our traditional medications and yet still, they’re in withdrawal, still very uncomfortable, still having cravings, and still have ongoing use. In the Downtown Eastside, fentanyl is what is sold. It is very hard to find other opioids like heroin anymore from organized crime. Fentanyl is the molecule that most people’s brains have become accustomed to.”
Fentanyl, either alone or in combination with other drugs, was detected in 85 per cent of toxic drug deaths in 2021. But Sutherland stresses this is not because of the substance, but rather the circumstances in which people are using it. Increasingly, the supply is tainted with unknown quantities of other substances like benzodiazepines and carfentanyl, an analogue that can be up to 100 more times more potent.
“Fentanyl itself — it’s just a molecule. The challenge with the system we have now is that organized crime is in charge of the supply chain, in charge of the dosing, and in charge of the pricing of drugs. And they can’t be trusted to do it properly,” she explains.
“When people buy drugs on the street, they don’t know the contents and they don’t know the strength, and there’s high risk of there will be poisonous substances inside.”
Patients work with clinic staff in order to calibrate the dosage they will be described. The drug itself is in clearly-labelled, different doses are colour-coded.
“We can be sure when we talk with our patients whether it’s the same dose and same content in every capsule, whereas organized crime on the street is not able to provide those standards and safety,” Sutherland added.
It will run parallel to existing safe supply initiatives at PHS, and be available to patients who have already stabilized. Sutherland says this new option is unique because it doesn’t require multiple visits to a clinic, and for substances to be used on site.
“This is a way to graduate from medical models into a different framework for how they access their drugs — in that it’s take-home and payment — so they’re able to go back to work, spend time with their families, go back to school, do all of those wonderful things that we want them to do,” Sutherland says.
The first prescription was written on April 7, and intake for the program is ongoing among patients already connected to PHS’s clinic. But Sutherland thinks the model can be easily expanded, particularly because it’s fairly low cost. The take-home model doesn’t require as much staffing or infrastructure as some other safe supply options, and the patient is paying for their prescription at a rate comparable to what they would pay on the illicit market.
Sutherland also emphasizes that the drugs people will be getting through this program are legal – it won’t be a crime to possess, carry, or use them.
“I can go to the liquor store and I can buy wine. I don’t go down to Main and Hastings and buy illicitly produced wine. There’s no market for organized crime to be making their own wine because everyone in British Columbia has access to safe wine,” she says.
“I want to create that same safety for my patient population.”
She does note that a prescription, visits to a clinic, and some medical supervision are still required in this program, making it different from other safe supply models that are completely de-medicalized – an option that Sutherland and PHS support.
The compassion club model, staffed by peers and run by community groups, would create spaces where people would be able to purchase illicit drugs that have been tested. Vancouver-based drug-user advocacy groups have applied to Health Canada for an exemption to the Controlled Drugs and Substances Act that would make a pilot project possible. Advocacy groups will be rallying for support of this on Thursday, distributing a tested supply of heroin, cocaine and methamphetamine to their members.