Clinic business

British Columbia clinic is the first in Canada to legally sell take-out fentanyl

Until now, prescribed fentanyl had to be used on-site under the supervision of a healthcare professional

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More people in Vancouver can now buy and take fentanyl home, thanks to the expansion of a Downtown Eastside program that offers the high-potency opiate at street prices to patients with prescriptions.

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However, crime experts question whether the first program in Canada, which recently sold its first tenth of a gram of fentanyl to a patient for $10, is enough to disrupt an industry that is seeing $300 million land in the hands of criminals. every year. .

Dr Christy Sutherland, medical director of PHS Community Services, the social service organization behind the program, said its aim was to separate patients from an increasingly contaminated illicit drug supply.

For several years, she has prescribed fentanyl at the Columbia Street Clinic through prescribed secure supply programs that allow people to use injectable doses or patches of fentanyl at no charge, but only onsite under medical supervision. April 7 was the first day she saw one of her patients leave with the powdered medicine in hand as part of a new take-home model, which is not covered by Pharmacare but still approved as treatment in British Columbia.

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“Making patients pay is like having a built-in safety mechanism for their supply,” Sutherland said. “Medicine becomes regulated in terms of exactly what a dose contains, how it is packaged and labeled as an active prescription.”

But Michael Porteus, a former Vancouver police superintendent who has spent more than three decades investigating drug gangs, said he doesn’t “think Vancouver is going to win the war on drugs this way.” .

He thinks professional criminals will catch on and start peddling a new compound that promises DTES clients “the best high they’ve ever had.”

“I wish it worked, but in my experience as a detective, professional drug trafficking rings will push to produce a superior or ‘superior’ product, undermining the initiative.”

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Porteus said allowing patients to take fentanyl prescriptions home could lead to illicit resale of the capsules, similar to what happened in Canada in the 1990s after doctors prescribed the new opiate OxyContin to patients. to deal with chronic pain.

Sutherland said, “with robust admissions measures and ongoing monitoring of patients in the clinic,” the PHS program seeks to do the opposite.

“With OxyContin, no due diligence was taken by the physician group, there was pharmaceutical influence and a profit motive,” the doctor said. “PHS does not make money from this program – we are a non-profit organization whose nurses and clinicians, including me, are paid a standardized hourly wage.”

Researchers estimate that DTES opioid users spend an average of $65 a day on fentanyl adulterated illicit substances. Provincially, it’s $300 million a year.

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In 2020, fentanyl accounted for 90% of opioids sold on the illicit drug market in British Columbia, according to the Center on Substance Use.

“With criminals controlling the supply chain, there are no regulations for consistent dosing, which with fentanyl can be as small as a grain of sand,” said Sutherland, who with a team other physicians and nurses, serves nearly 1,200 DTE patients.

“My sweet patients overdose over and over again,” said Sutherland, who has responded to many overdose victims outside of the clinic.

Last year, illicit fentanyl was detected in 83% of 2,224 suspected toxic drug deaths in British Columbia, according to preliminary data from the BC Coroners Service.

Porteus, who saw Vancouver opiate dealers stop selling heroin in the mid-2010s, said fentanyl is easy to acquire from dark web retailers, who ship in batches from China. He said the drug is also cheaper.

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“You can produce hundreds of doses with just a pinch of fentanyl. The problem is, it only takes one extra pinch to make a dose fatal, and there’s no quality control.

For the PHS program, Sutherland worked with a Canadian pharmaceutical company to develop capsules, buffered with caffeine and dextrose (a sugar), that can be smoked, snorted or cooked for injection.

Once prescribed, patients can pick up their doses, which vary according to their level of tolerance, at the clinic’s pharmacy and continue with their day. Hundreds of people in the community are eligible to enroll in the program, Sutherland said.

“I have at least a few hundred of my own patients that I want to start the program,” she said. “But it will take time.”

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Patients must have a substance use disorder and have their medical history, prescription history, and physical condition reviewed by a physician to be eligible. If approved, a clinic nurse facilitates the titration process with a supervised dose of fentanyl that eventually replaces the patient’s illicit drug use.

Sutherland wants the program to be expanded to other municipalities in the province to reduce drug poisoning deaths.

“When patients start our programs, getting their next drug supply is not a constant threat. They go back to doing things they love instead of experiencing the excruciating vomiting, diarrhea, sweating and pain that comes with withdrawal.

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