Vancouver organization launches first-ever paid prescription fentanyl program

Patients in Vancouver’s Downtown Eastside will soon be able to access paid prescription fentanyl to take home and use, an option the doctor in charge of the program says will allow people to escape “the violent system of trying to see your drug dealer and stay away from withdrawal every day.”

An initiative of the PHS Community Services Society, the Expanded Access Program is an effort to expand access to a safe supply of medicines, as the death toll from the illicit and toxic supply continues unabated. A BC Coroners Service report released on Tuesday says 174 people died in February 2022 – equating to more than six people dying every 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 from the illicit market.

“I can see over the years that the drug supply chain has changed, that we are no longer able to meet the needs of our patients,” Sutherland said.

“I can see them taking massive doses of our traditional medications and yet they’re in withdrawal, still very uncomfortable, still having cravings and still using it. In the Downtown Eastside, fentanyl is what is sold. It’s very hard to find other opioids like heroin in organized crime. Fentanyl is the molecule that most people’s brains have become accustomed to.

Fentanyl, alone or in combination with other drugs, was detected in 85% of toxic drug deaths in 2021. But Sutherland points out that it’s not because of the substance, but rather the circumstances in which people use it. Increasingly, the supply is tainted with unknown amounts of other substances like benzodiazepines and carfentanyl, an analogue that can be up to 100 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 dosage and in charge of the pricing drugs. And they can’t be trusted to do it right,” she explains.

“When people buy drugs on the street, they don’t know the contents and they don’t know the strength, and there is a high risk that there are toxic substances inside.”

Patients work with clinic staff to calibrate the dosage that will be described to them. The medicine itself is clearly labelled, the different doses are color coded.

“We can be sure, when we talk to our patients, if it is the same dose and the same content in each capsule, while organized crime on the street is not able to provide these standards and that security,” Sutherland added.

It will work alongside existing safe supply initiatives at the PHS and will be available to patients who are already stabilized. Sutherland says this new option is unique because it doesn’t require multiple visits to a clinic and the substances must be used on the spot.

“It’s a way to move from medical models to a different framework for accessing their medications – in that it’s take-out and pay-to-use – so they can get back to work, spend time with family , go back to school, do all these wonderful things that we want them to do,” Sutherland says.

The first prescription was written on April 7 and admission to the program is underway among patients already connected to the PHS clinic. But Sutherland thinks the model can be easily scaled up, especially because it’s relatively inexpensive. The take-out model does not require as much staff or infrastructure as some other safe supply options, and the patient pays for their prescription at a rate comparable to what they would pay on the illicit market.

Sutherland also points out that the drugs people will get 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 to buy illegally produced wine. There is no market for organized crime to make their own wine because everyone in BC has access to safe wine,” she says.

“I want to create the same safety for my patient population.”

She notes that a prescription, clinic visits, and some medical supervision are still required in this program, which makes it different from other safe supply models that are completely demedicalized — an option that Sutherland and PHS support.

The compassion club model, made up of peers and run by community groups, would create spaces where people could buy illicit drugs that have been tested. Vancouver-based drug user advocacy groups have asked Health Canada for an exemption to the Controlled Drugs and Substances Act that would make a pilot project possible. Advocacy groups will rally in support of the initiative on Thursday, distributing a tested supply of heroin, cocaine and methamphetamine to their members.

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