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A Domestic Safe Supply of Injectable Heroin Would Save Lives

And a new BC company has just formed to produce it. It’s up to the province now.

Jordan Westfall and David Mendes 10 Aug 2020TheTyee.ca

Jordan Westfall and David Mendes are the co-founders of the non-profit Canadian Association for Safe Supply.

For so many in British Columbia living at risk of overdose, as well as across Canada, the recent announcement of a new pharma company focused on creating a safe supply of pharmaceutical heroin is a lifeline.

B.C. yet again recorded the worst month in its history for overdose deaths, with 175 dead in June, topping May’s record-breaking total of 171.

The vast majority of the deaths were caused by an unpredictable illicit drug supply used by people following the provincial directive to isolate in place and stay home during the pandemic. In many of Vancouver’s Downtown Eastside single-room occupancy hotels, COVID-19 self-isolation measures include “no guest” policies that left many people at risk of overdose to use drugs by themselves.

It isn’t just those living in the Downtown Eastside who are dying. Certain workers, like those in construction, are over-represented in overdose death totals, representing 55 per cent of overdose deaths among the employed.

Considering that there are many thousands of people at risk of overdose in B.C., it is long past time for the provincial government to expand pharmacare coverage to include injectable opioids like prescription heroin, which, combined with treatment, can save lives.

Let’s close this gap leaving so many British Columbians uninsured and without legal alternative to the illicit market. With available prescription drugs and pharmacare coverage, at least people have the option of using a regulated drug they obtained from a pharmacy instead of from the unpredictable illicit supply. It should be an option for anyone at risk of overdose.

The pandemic finally compelled the provincial government to offer some illicit drug replacement options through the British Columbia Centre on Substance Use’s Dual-risk Mitigation prescriber guideline. This guideline provides clinical advice to prescribers wanting to support physical distancing among people at risk of overdose.

If the province extended pharmacare coverage for injectable opioids, and prescription heroin was added to the Dual-risk Mitigation guidelines, there would finally be a broadened pathway for people at risk of overdose to get injectable opioids on prescription.

Fair Price Pharma, the new company planning to produce injectable heroin (diacetylmorphine or DAM) is a key part of the solution. It would mean domestic production of a much-needed replacement for the illicit drug supply can finally become a reality in Canada.

Leading Fair Price Pharma is Dr. Perry Kendall, B.C.’s first medical health officer, and Dr. Martin Schechter, the lead researcher behind NAOMI, Canada’s heroin-assisted treatment clinical trial. Kendall’s decades of experience provide significant legitimacy to the project. As B.C.’s first health officer, he was responsible for declaring the overdose crisis a public health emergency. Schechter’s research with NAOMI and other studies provide the Canadian evidence base underpinning the movement in support of safe supply, or other legal alternatives to illicit drugs.

Together, they bring decades of knowledge and experience in the health sector to Fair Price Pharma. Their work will be supported by the BCCDC Foundation for Public Health, which is exploring the idea of raising capital for the project.*

Right now, the only drugs that the Dual Risk prescriber guidelines recommend are tablets (including opioids, stimulants and benzodiazepines) approved only for oral use. This was a badly needed first step, but now the work to make a drug supply inclusive of people who use injection drugs has to begin. It’s time for the provincial government to take that next step and expand pharmacare coverage for injectable opioids like heroin.

Currently, the only pharma coverage for injectable opioids in B.C. is strictly tied to B.C.’s injectable opioid agonist treatment program, and only available to the 220 or so participants in that program. Expanding pharma coverage would mean many more people at risk of overdose would have a lifesaving drug covered under their prescription plan.

In other jurisdictions, prescription heroin has ended overdose epidemics. A recent evidence review by the Canadian Agency for Drugs and Technology in Health found that pharmaceutical heroin in conjunction with treatment was both cost-effective and in fact “dominated” oral substitution therapies like methadone and suboxone when it came to keeping people in treatment and health benefits.

For nearly five years, B.C.’s overdose crisis, the province’s first public health emergency, has continued without a crucial intervention that, based on existing evidence, has ended overdose crises in Denmark and Switzerland. This model incorporates the provision of pharmaceutical grade heroin, in a clinic setting with additional social and health-care supports.

Compared to B.C.’s current iOAT programs, Europe’s programs provide greater autonomy for participants, who have the ability to take home doses. In B.C.’s programs, most participants must attend a clinic up to three times a day. In order to promote effective physical distancing, the pandemic provides an opportunity to remove these barriers and ensure that B.C.’s iOAT participants have the option of take-home doses.

The government should welcome innovative solutions like Fair Price Pharma as an opportunity to end the overdose crisis. The government could put up the funding that Fair Price Pharma needs for safety testing and production of the drug, and contract it to manufacture and distribute pharmaceutical grade heroin in co-ordination with an expansion of provincial pharmacare coverage of the drug.

According to Fair Price Pharma’s leadership, about $3 million needs to be raised to launch their injectable heroin product.

If there was any investment worthwhile for the provincial or federal government to save lives during an overdose crisis, it is Fair Price Pharma.

*Story clarified Aug. 14 at 11:30 a.m.  [Tyee]

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