A program believed to be the first of its kind in Canada will launch in early January in the Downtown Eastside and allow 50 drug users to access a prescription painkiller tablet and inject it while in a monitored facility.
Coco Culbertson, senior manager of programs for the PHS Community Services Society, said participants will be given hydromorphone tablets — a pain management opioid to reduce cravings for heroin — that they will be allowed to crush and inject inside one of the society’s overdose prevention sites.
“Continuing to have people live in this prison of overdose-reverse-repeat is not good enough,” said Culbertson, after speaking to city council Thursday on the need for more treatment options to reduce the number of drug deaths in Vancouver. “So we feel we are tasked with doing something better for our community.”
Added Culbertson: “If we’re successful, I think it’s a game-changer.”
The site is located inside the Molson Bank building at 166 East Hastings, a location seen as ground zero for the ongoing overdose death crisis that has claimed more than 300 lives in Vancouver this year for the second consecutive year.
The program is a partnership with Vancouver Coastal Health and will be evaluated by the B.C. Centre on Substance Abuse. Culbertson said the program is not considered illegal because it is a prescription-based program, which is staffed with a nurse and mental health worker.
Culbertson stressed that program participants will not be allowed to take the tablets home. The PHS, which co-operates the Insite supervised drug injection site with Vancouver Coastal Health, already runs a program for drug users who rely on injectable hydromorphone.
But having a program where drug users can crush the tablet form of the drug and use it in a monitored facility is a new initiative and believed to be the first of its kind in Canada, she said, noting the practice is used widely on the streets, where the drug supply is contaminated with lethal fentanyl and continues to kill people.
"We know that drug users on the street like Dilaudid tablets," she said, referring to the brand name of hydromorphone. "Injection drug users love them. The street value can range between $10 [for a small tablet] to $30."
The program complements a variety of treatment measures and options for drug users in Vancouver, including the use of methadone, buprenorphine-naloxone, morphine and diacetylmorphine, which is available to participants connected to the Crosstown Clinic in the Downtown Eastside.
Culbertson didn’t disclose the budget for the program but said the hydromorphone tablets, which cost about 32 cents each when purchased in bulk, are cheaper and more available than expensive liquid hydromorphone.
Culbertson cited many advantages to the program, including connecting drug users to health care, reducing their need to commit crimes to feed their drug habits and, ultimately, preventing them from dying of a drug overdose.
“We’re hoping to create a model that’s replicable across the country because it’s cost-[efficient], it’s low barrier and it’s rapid response,” she said.
Dr. Mark Tyndall, the executive director of the B.C. Centre for Disease Control, said the move by the PHS to launch the program is an important step to provide more options for drug users. He echoed Culbertson's point that many drug users already crush and inject hydromorphone pills in the streets.
“There’s still some pushback [from pharmacists] that people shouldn’t be crushing pills and injecting them, although we know that’s what most people do all the time,” he said. “I do think it’s an important step to say, ‘Look, this is what people do anyway, so we can do it in a relatively safe fashion.’”
Tyndall said such a program may help push his initiative to set up dispensing machines stocked with hydromorphone pills. He is currently pushing Health Canada and senior levels of government to allow such machines for drug users seeking clean alternatives to the contaminated drug supply.
While discussions continue, Tyndall said he is working with the City of Vancouver to establish a storefront in the Downtown Eastside to connect drug users with hydromorphone pills. That storefront, he said, may eventually be the site for a dispensing machine.
“We’re working on getting the machine ready but because of questions we’ve had, we’re going to be trying this model without the technology to start with,” he said, noting some housing providers have programs where pills are distributed. Users, he said, could be linked to that system. “So the storefront, initially, would be clinical space. I don’t want to give the message that this is going to be a storefront where we’re going to be actually giving out pills.”
Sarah Blyth, founder and executive director of the Overdose Prevention Society, said she supports the PHS’s program but noted it has to be more widespread to respond to the magnitude of the overdose crisis.
“Fifty people is a start, but we need thousands of people [on such a program],” she said, noting a machine used to test drugs at the society’s injection site on East Hastings has not only found fentanyl, but plaster, cleaning agents and pig de-wormer in street drugs. “So we need to get people a safe supply. That, in itself, is recovery in a lot of ways—they know what they’re taking, they know what dose it is… so they can regulate what they’re taking.”
Blyth, Tyndall and Culbertson were all in the council chamber Thursday to urge city council to approve a series of recommendations worth $500,000 aimed at responding to the overdose crisis, including setting up inhalation sites for people who smoke drugs; B.C. Coroners Service reports have shown up to 40 per cent of deaths were linked to fentanyl.
Other recommendations called for the expansion of injection sites in single-room-occupancy hotels, more support for Indigenous wellness and healing programs, a wider distribution of fentanyl-testing strips and increased funding from the provincial and federal governments.
Council was still hearing from speakers when the Courier posted this story.
Last year, the total number of overdose deaths reached 367 in Vancouver, which was a substantial increase over the 234 in 2016 and 138 in 2015. In the past decade, the lowest number of overdose deaths occurred in 2008 when 38 people died.
Fentanyl has been responsible for the surge in deaths, with 79 per cent this year connected to the deadly drug. Last year, 81 per cent of deaths were connected to fentanyl, 65 per cent in 2016 and 23 per cent in 2015. In 2012, when 65 people died of an overdose in Vancouver, only two per cent were linked to fentanyl.