Original Published 20:26 Apr 14, 2022

By Moira Wyton, Local Journalism Initiative Reporter

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.

This item reprinted with permission from The Tyee, Vancouver, British Columbia