Canada - B.C. pilot project to distribute hydromorphone pills

[S.J.B.]

B.C. pilot project to distribute clean opioids to people at high risk of overdose
Andrea Woo
The Globe and Mail
December 19th, 2017

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.

Read the full story here.

 

[S.J.B.]

I was quite happy to see this in the news yesterday! As usual, British Columbia is on the forefront of radical drug-policy reform.

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."

Exactly! When the vast majority of people are dying from fentanyl-adulterated street drugs, the diversion of 8 mg hydromorphone pills won't do any harm. Plus, it should drastically reduce the demand for street opioids generally once the program is scaled up enough. And it can certainly be scaled up, because:

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.

$700 a year! For 50 mg per day of hydromorphone per day, which is nothing to sneeze at (equivalent to ~100 mg of pure heroin). This is the epitome of low-cost, low-barrier harm reduction.

One caveat: I really hope they give out micron filters if they are going to be giving these pills out with the knowledge that they will primarily be injected. There should be clear education on the issues with injecting pills and how to avoid them.

It would be better to provide ampules of hydromorphone to those people who will be injecting, but the cost difference is huge, so I can understand why they went with pills.

 

[Tubbs]

Mmm if Canada wasn't so damn cold in the winter id consider moving

 

[Jabberwocky]

Go BC!

I’m reading a book about those guys as we speak

(actually more than one lol)

 

[S.J.B.]

I’m reading a book about those guys as we speak

(actually more than one lol)

Are you reading the one by Travis Lupick?

 

[Jabberwocky]

Nope but now I want to what is the title? I’m reading a new edition of hungry ghosts and the globalization of addiction.

 

[S.J.B.]

Nope but now I want to what is the title? I’m reading a new edition of hungry ghosts and the globalization of addiction.

Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction. Lupick is a Vancouver-based journalist who focuses on drug policy. I haven't read it yet but it sounds very interesting, especially having met some of the personalities central to the story.

 

[Jabberwocky]

Very cool, and obviously right up my alley. I’ll definitely be adding it to my list. Thanks for the idea!

 

[ro4eva]

I am proud of, and admire B.C. for consistently being at the forefront of progressivism in Canada. That said, I'm not sure how I feel about being given carry doses of Dilaudid. But, if the prescribing physician judges that the benefits outweigh the risks, then I defer to his or her expertise. I am all for steps taken to undo the futile, wasteful, draconian war on politically-incorrect drugs.