A first-of-its-kind program is making powdered fentanyl available by paid prescription in Vancouver.
Dr. Christy Sutherland, medical director for PHS Healthcare, the organization running the program, said the goal is to meet substance users where they are at, instead of administering alternatives like Dilaudid that patients may not find helpful.
“The common feedback we had from patients was that they would prefer fentanyl, that we needed to match what they were buying from the drug dealer in order to get them away from that street supply. So we worked as a team to create a new fentanyl option for our patients and community,” she said, speaking on CBC’s On The Coast.
The opioid crisis continues to take a devastating toll in British Columbia, with an average of six people dying of illicit drug poisoning every day.
Fentanyl is now the street drug of choice, but increasingly it’s being cut with all manner of toxic substances, including benzodiazepines and carfentanil, a much more potent analogue of fentanyl.
“When we think about organized crime cooking fentanyl in these clandestine labs and trying to dose it out into dime bags, there’s no way that they could make a consistent dose from unit to unit. And so people don’t know how much they’re taking at a time,” said Sutherland.
How the program works
The “enhanced access” program at PHS starts with a robust intake regime, said Sutherland, including a nurse who works with the patient to determine the correct dosage and prescription.
The patient then takes that prescription to a pharmacy, pays for the fentanyl just like any other medication, takes it home and uses it on their own schedule.
The thinking is that a safe and consistent supply removes the need to interact with the criminal drug world which helps bring stability to the patient’s life.
“They get their own unique prescription that is exactly the dose they need,” Sutherland said. “Think about the agony of opioid use disorder, of always being in withdrawal, always having uncertainty…. To know that you’re not going to wake up at St. Paul’s Hospital post-overdose, having had your belongings stolen from you or having been assaulted along the way.”
Leslie McBain, co-founder of Moms Stop the Harm, said the program will save lives.
“It’s well thought out. It is legal. It is regulated. There’s pharmacists and medical people involved and in a setting that is low barrier and non-stigmatizing. I think it’s fantastic,” she said.
McBain said concerns that patients will resell their prescription fentanyl are unfounded.
“When a person gets what they need in a safe setting, there’s no sort of impetus to go out and sell it,” she said. “Why would a person … sell it to go get something else that’s dangerous and possibly fatal?”
Sutherland said another positive of the program is that possessing prescription fentanyl is not illegal.
“This is a legal prescription. It’s labelled with your name and the contents of the prescription in a prescription vial. They also have a receipt for the purchase of the prescription and have an active prescription on file at the clinic,” she said.
The enhanced access program began on Thursday with a single client. Sutherland said data is being collected to evaluate the effectiveness of the program and believes the model could be scaled up quickly in other B.C. locations.
“For that one person who started yesterday, just the dignity and respect you get from filling a prescription and paying for it and taking it home, is a lot. And that’s how I want to treat my patients,” she said.