Urgent need for injectable addiction treatment in B.C.: addictions minister

VANCOUVER—British Columbia’s addictions minister has tasked health authorities to move quickly to scale up use of an injectable drug that could save the lives of chronic substance users who haven’t responded to treatment with oral medication.

Judy Darcy said hydromorphone is urgently needed for people struggling with addictions and B.C. would be the first place in North America to use it as part of clinical practice.

“If we’re going to save lives and prevent people from being poisoned from toxic drugs on the street we need to provide alternatives and this is an alternative that has been proven by evidence to work,” she said Wednesday.

Darcy was responding after the B.C. Centre on Substance Use released a report providing doctors with guidelines on hydromorphone, which is used at the Crosstown clinic in Vancouver, where some patients addicted to heroin receive injections of pharmaceutical heroin under supervision.

Suboxone and methadone are the first- and second-line medications to treat substance use disorder but Darcy said hydromorphone would be another option for people who’ve failed with those treatments.

“We’re asking health authorities to give us plans about how to implement this,” she said. “We’ll be waiting to hear back from them on an urgent basis about what that looks like.”

The results of a groundbreaking trial in 2016 involving Crosstown patients showed hydromorphone, or pharmaceutical heroin, is equally effective at treating heroin addicts who don’t respond to methadone or suboxone.

Cheyenne Johnson, a nurse and clinical director at the B.

C. Centre on Substance Use, said the Crosstown study of 202 participants suggests hydromorphone must be made available to more people through clinics and pharmacies, the same as for methadone.

“This being a new and emerging model in B.C., what we want to do is work with the health system and evaluate and monitor the expansion of this program to see what works and where the gaps are and address those,” she said.

The B.C. Centre on Substance Use guidelines propose a continuum of care including counselling, detox or withdrawal management services, then oral medication through to injectable treatment.

The guidelines also include information on when patients are eligible for treatment, how to provide adequate dosing and monitoring and when to do urine drug tests.

While pharmaceutical heroin is also effective for some chronic substance users, prescribing it comes with regulatory hurdles because doctors must apply to Health Canada for individual patients who use the drug that’s imported from Sweden.

“We’ve been slow to expand hydromorphone,” Johnson said. “The evidence from our perspective is very clear that hydromorphone is an evidence-based treatment option and we have to expand it across the province.”

The high rate of addiction in the province has placed a heavy burden on communities dealing with crime, public disorder and health costs, Johnson said.

More than 1,800 people died of overdoses in B.C. between January 2016 and July 2017, many of them involving the painkiller fentanyl.

Over 40 people took part in the report, including drug users, family members, community advocates, physicians and researchers from Germany, Switzerland and the Netherlands, where prescription heroin has been used for addiction treatment.

They included Jordan Westfall, president of the Canadian Association of People Who Use Drugs, who said treatment needs to be accessible for people who need help during an opioid epidemic.

“The awareness of this situation in the public’s mind has to continue,” he said, adding any funding concerns “need to go out the window” for an issue that involves a health crisis.

“Ultimately, it’s up to people who use drugs to speak up about this, and not let pressure off the government,” said Westfall, who is a former drug user and has a master’s degree in public policy.