‘I Want Them to Break Up with Their Drug Dealer’

A groundbreaking new program from Vancouver’s PHS Community Services Society will allow people to buy fentanyl instead of relying on the increasingly contaminated and unpredictable illicit supply.

The new enhanced access program is a major step in expanding safe supply as government promises of action have stalled.

Substance users and public health experts say such regulated drug sales are essential to ending the toxic drug crisis emergency as it nears its sixth anniversary. More than 9,000 people have died since the public health emergency was declared.

The program made its first sale Thursday. It is legal because the fentanyl — already widely used medically for pain management — is prescribed.

PHS medical lead Dr. Christy Sutherland said the benefits should be huge.

“This program gives people dignity, it treats them just like every other person for how they access medication,” she said. “This is an exit from the Downtown Eastside, it's an exit from the daily grind and it's an exit from violence and HIV risk.”

“I want them to break up with their drug dealer.”

The illicit market is currently saturated with fentanyl, an opioid 100 times more powerful than heroin. Fentanyl has been found in many other substances sold on the illicit market. In 2021 it was found to have contributed to 84 per cent of the 2,332 deaths due to toxic drug poisoning in B.C.

“Organized crime is controlling the supply, the content and the price of drugs, for some people, but not others,” said Sutherland. “Why can I go and buy a bottle of wine, of a known quantity and purity… but my patients who are using opioids do not have that option of safety?”

Many people using substances have become habituated to fentanyl’s potency, and can no longer be stabilized on other prescription options like heroin, methadone or Suboxone, Sutherland and her colleagues have observed.

Fentanyl is now required in order to provide a viable alternative to the illicit supply for people who use opioids like heroin or fentanyl itself.

“This patient population deserves the same safety, and that the longer we wait before we intervene, the further along the poisonous drug market will go, and the higher their tolerance will be,” said Sutherland, who has worked in the Downtown Eastside for 12 years. PHS is a non-profit that runs harm reduction services, housing and other resources in the neighbourhood.

“If I were doing this 100 years ago, I’d be prescribing opium tea.”

Patients will be assessed and prescribed powdered fentanyl, with buffers caffeine and dextrose, in capsule form. It can be snorted, smoked or cooked for injection.

Patients will all have access to a full suite of primary care, as well as optional additional treatment and recovery resources.

Patients will initially have to use the fentanyl through injection or snorting under the supervision of a PHS nurse. Once appropriate doses are established, they can begin to take capsules home daily and larger quantities from the pharmacy less frequently.

Sutherland worked with a national pharmaceutical supplier and a local compounding pharmacy to obtain and process the fentanyl.

The fentanyl will be sold at market value, about $10 for a tenth of a gram, known as a point. It is not covered by PharmaCare. This reduces the incentive to resell or risk of diversion, Sutherland says.

The program’s flexibility also provides more freedom for patients to live and work as they aren’t required to attend at the pharmacy every day for witnessed consumption or daily dispensing.

“If people are stabilized, they switch to a less dangerous route of use, because they feel secure in their supply, and they're not going to go into withdrawal,” said Sutherland, noting that smoking carries less risk of infection or harm to veins than injection.

The program is only open to her current patients right now, but she says there is capacity to scale-up to reach hundreds and even thousands of people across B.C.

The program is being evaluated by the BC Centre on Substance Use, which Sutherland hopes will help establish the evidence base in support of other modes of safe supply in B.C., including compassion clubs and other non-medical models.

In a way, the groundbreaking program is “business as usual” for doctors, who prescribe medications for their patients every day.

“We’re just giving someone a mechanism to purchase them in a safe way, rather than having to navigate the system of danger and violence with organized crime,” said Sutherland.