Vancouver Coastal Health’s chief medical officer is urging health authorities to make it easier for people to start and stay on treatments for addictions as a way to spare lives during B.C.’s continuing overdose crisis.
Dr. Patricia Daly presented an update on the crisis at a public board meeting Wednesday that included four recommendations. She wants the health authority to implement treatment standards and monitor outcomes for patients’ addictions care, expand access to “opioid-agonist therapies” such as Suboxone and methadone, establish a safe and regulated supply of drugs, and expand addiction-prevention programs.
Daly’s first recommendation is to ensure that people who begin treatments for opioid addiction don’t slip through the cracks over time. She said residential treatment centres should have a standard of care and keep track of patients’ treatments.
“When we start people on treatment for their opioid addiction, they’re not retained on treatment in the long-term. So we need to have a system that will really track people over the long-term, including when they go into detox and recovery,” Daly told Postmedia. “There are people who are dying who just left detox and recovery because they’re not put on opioid-agonist therapy or being maintained on it.”
Daly wants it to be easier for people to access treatment in the first place. Many aren’t wiling to go to visit a clinic to begin opioid-agonist therapies, so the health authority needs to consider dispensing such treatments from emergency departments, and working with pharmacists to make it easier for people to access methadone, including at multiple pharmacies, Daly said.
People who are subsequently hospitalized or jailed must not miss doses of those treatments and risk relapse, she added.
Despite the expansion of harm-reduction measures such as naloxone and overdose-prevention sites, people are still dying from a fentanyl-poisoned street drug supply, which is why Daly is recommending a safer supply for people when other treatments fail.
She pointed to four sites offering injectable therapies, including a pilot program run by Dr. Christy Sutherland of the Portland Hotel Society which has started more than 300 people on injectable hydromorphone since 2016, and which in January introduced a tablet version of the drug for 50 new participants to crush and inject under observation.
The B.C. Centre for Disease Control has been planning for a similar pilot program that allows participants to take the pills with them, which Daly said is important for people who struggle to make multiple daily visits for supervised injection.
“I think we have to acknowledge that we’re in this crisis because of what’s happened to the illegal drug supply, and people are going to consume illegal substances,” she said. “We have to do everything we can to reduce the risk of people developing substance-use disorder, providing evidence-based treatments.”
Ensuring access to stimulants should be a next step, Daly added.
According to her report, 39 per cent of people who died of an overdose in Vancouver in 2017 used opioids daily, but another 19 per cent drank alcohol daily, 12 per cent used stimulants daily, and 18 per cent used both alcohol and stimulants daily.
Finally, Daly wants to see expanded addiction-prevention programs for youth, people living with chronic pain and First Nations people, who are five times more likely than non-First Nations people to experience an overdose, and three times more likely to die.