In North American first, Vancouver clinic lets patients take heroin home

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A Vancouver clinic that prescribes medical-grade heroin to treat opioid addiction is allowing some patients to take home dosages — a small but significant step in a province that is opening the door to a safer drug supply.

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About 90 patients currently use prescription heroin (diacetylmorphine) at the Providence Crosstown Clinic, visiting the clinic two or three times a day to be injected under medical supervision.

During the pandemic – prompted by the constraints of physical distancing and to support patients being isolated – staff began distributing a day’s worth of syringes to some patients. By July, about a dozen patients were allowed to go to the clinic for their first dose of heroin and the remaining one or two to take home, the first in North American.

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Scott Macdonald, physician chief of Crosstown Clinic, said it had been clear for some time that some patients needed more flexibility in treatment to work and care for families. But the fear of something going wrong kept the program under a supervised model – until the pandemic forced change.

“COVID easing of rules allowed for more affordance and risk-mitigation to be prescribed. There was no increase in mortality, and people reported satisfaction with more flexible dosing options,” said Dr Macdonald.

“With this, we were able to show that it doesn’t have to be in a strictly medical setting, that it is safe and possible to seek care outside the clinic.”

Patients who are considered for a “carry” or take-home dose must be in a state of stable living – eg, at home and employed or at school. They must be able to safely transport, administer and store their transport and medical supplies, and a lost or stolen dose is not replaced on the same day.

The move comes as British Columbia prepares to implement a provincewide directive to provide drug alternatives to toxic street drugs. More than 7,760 people have had fatal overdoses in the province since 2016, up from an unprecedented rate of 38.9 for every 100,000 people so far this year.

With this increase in deaths from unsustainable drug supplies with unexpected amounts of fentanyl, benzodiazepines and other substances, the province is mandating all health authorities to develop and support “safe supply” programs, through which People using drugs may be prescribed regulated alternatives. For items bought on the street.

Prescribed safe-supply drugs such as fentanyl patches or tablets and injectable hydromorphone — as well as related pharmacy services — will be covered under the province’s drug plan, PharmaCare. However, the province remains silent on heroin. Stimulants are expected to be added at a later date.

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One Crosstown Client has worked as a unionized boom operator in the film industry for over 20 years. The man is not being named because he fears employment repercussions from his substance-use disorder.

At his lowest, he was homeless, living in “total and utter chaos” and struggling to keep his job, he said. Coming to Crosstown’s heroin program five years ago changed his physical and mental health, but showing up at the clinic twice a day still faces the challenges of working in an industry where 15-hour days are common.

“It was very difficult to go from one location site to clinic and back to location within a reasonable amount of time,” he said.

“Often I had to turn down calls because I couldn’t jeopardize my name in the union or in the sound department, possibly by not making it an easy day. You just can’t leave. Sound mixers won’t hire you if you’re known to be the person who does this. And I don’t blame them.”

He now presents at the clinic before work and takes his second dose with him. “Now, I have nothing to hold me back,” he said.

Donny Cinnamon, 63, described his similarly dire condition before starting the program in Crosstown, recalling that he was buying “and stuff like that” to get his fix for the day. Pharmaceutical heroin stabilized him, but the need to be in crosstown three times a day, three hours apart, meant he was tied to the clinic for at least half a day.

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He said that receiving carry has enabled him to work full shifts again. He recently completed a first aid course and is working at the front desk of an assistant-accommodation building.

“It really helped me, this program. I stopped using street dope and all that,” said Mr. Cinnamon.

“I see all these people getting used to here, and their lives are ruined. I don’t want to be like that anymore. I’m getting old, and it’s time to live my life where I can manage it.” “

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