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Daphne Bramham: B.C. group’s call for legally regulated heroin sales is unfounded

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The B.C. Centre on Substance Use is proposing the regulated, legal sale of heroin through co-ops whose membership would be “low-barrier” and whose boards would include addicts and users. It’s unprecedented and unfounded.

Tracey Loyer injects hydromorphone at the Providence Health Care Crosstown Clinic in the Downtown Eastside of Vancouver, B.C., on Wednesday April 6, 2016. A Vancouver study suggests severely addicted heroin users could be treated with an injectable pain medication. The Study to Assess Longed-Term Opioid Medication Effectiveness, or SALOME, found hydromorphone is as effective as a pharmaceutical-grade heroine for people who do not respond to methadone or suboxone. DARRYL DYCK / THE CANADIAN PRESS

Desperate times call for desperate and often unfounded measures. And, that’s exactly what a new report from the B.C. Centre on Substance Use is proposing in response to the unabating opioid overdose crisis.

It wants government to immediately clear the way for “heroin compassion clubs.” These would be free-standing co-op stores staffed by health care providers selling untainted heroin — diacetylmorphine — to members at the same price or less than street heroin. It would be free to members who can’t afford it, even though the report acknowledges that the risk of street resale of prescription opioids is greatest when the drugs are free.

And that would all be possible, the report says, because of things like volume discounts and “other economies of scale.”

“It would be precisely measured and dispensed in known quantities and at relatively safe doses,” says the report that was released Thursday. The emphasis has been added.

The heroin would be in powdered form, rather than an injectable liquid, just like it is on the street except this would be untainted heroin, not heroin cut with caffeine to prevent overdoses or any other additives to bulk up the product.

Members would be able to buy a couple of days’ supply and take it home with them.

Membership would be low-barrier, a term that’s not defined in the report.

Applicants would be screened by staff members who are “health care providers,” although not necessarily addictions physicians.

The co-op’s board members would be people with “lived experience” — a.k.a. users and former addicts.

Evan Wood, the head of the B.C. Centre on Substance Abuse, says the proposal is unprecedented so there is no evidence that it would reduce overdose deaths or disrupt organized crime’s role in fentanyl, money laundering or housing affordability, which is what’s advertised on the report’s cover.

“To be fair, we are in an unprecedented situation with fentanyl and the prescription opioids overdose crisis,” Wood said. “We are in uncharted waters.”

The two main goals are keeping users alive and disrupting the evils of organized crime.

These are ambitious albeit inappropriate goals for an organization whose mandate is to “develop, help implement, and evaluate evidence-based approaches to substance use and addiction.”

Using heroin to treat users isn’t new. But every other trial or program has a treatment component whether they’re at Vancouver’s Crosstown Clinic, the PHS Community Services or in European countries.

In Europe, heroin is prescribed with the goal of stabilizing users to a point where they can get jobs, form relationships or switch to other (cheaper) opioid replacement therapies such as methadone or Suboxone. (The annual cost per patient in European prescription-heroin programs ranges from $19,000 in Switzerland to $30,000 in the Netherlands.)

But there’s nothing like this in Canada.

“I’m not aware of the existence of ‘heroin clubs’ anywhere else,” Jann Schumacher from the Swiss-based Ticino, an organization of addictions specialists, said in an email. “In Switzerland the heroin assisted therapy is strongly regulated and always under medical control.

“Our Swiss model (heroin assisted treatment) has strong evidence as a harm reduction method, in getting people into treatment and stabilizing their lives, and in reducing the illegal market.”

To qualify, Swiss patients must have at least two years of opioid dependence and at least two failed tries using other addictions treatment methods. They are only allowed to the drug in pill form and take it with them after being in the program for six months and only if it’s necessary to hold down a job.

Drug-related crime in Switzerland has decreased 90 per cent. But compassion clubs would have no effect on drug-related crimes because members would still have to find some way to buy the heroin.

As for disrupting organized crime, the report suggests that compassion clubs would be competing for sales, influencing both the demand and market for heroin.

“The establishment of a regulated and controlled supply of fentanyl-unadulterated heroin may increase demand for street heroin among persons who use street opioids and force organized crime groups to return to the provision of heroin as part of the illicit drug market,” the report says.

And since violence is criminals’ usual response to unwelcome competition, it seems likely that they will attempt to terrorize compassion clubs out of business.

What makes this proposal all the more absurd is that it is aimed only at British Columbia. Surely, low-barrier access to pure heroin would be a magnet to every opioid user across the continent, let alone Canada.

British Columbia is already the epicentre of the overdose crisis just as it was ground zero for the cannabis legalization movement that began with compassion clubs dispensing so-called “medical marijuana,” which led to an explosion in unlicensed and unregulated pot shops.

It’s also where Canada’s harm-reduction model was birthed with free needles, supervised injection sites and readily available naloxone. But it was supposed to be part of a four-pronged strategy just as Switzerland’s is — a strategy that includes access to treatment and recovery as well as education aimed at dissuading drug use.

But since 2017, the $608 million spent by the B.C. government has gone almost exclusively to harm reduction. Yet, the number of overdose deaths is still rising.

It’s clearly not working and Canadians can’t help noticing now that 9,000 are dead including more than 4,000 in British Columbia. According to an Angus Reid poll released last week, 85 per cent of Canadians want mandatory treatment for opioid addiction. Forget legalization or free drugs, decriminalization was favoured by only 48 per cent.

Although the B.C. Centre on Substance Abuse is proposing a radical and untried solution, Wood dismissed mandatory treatment as an option because it’s unsupported by evidence.

As for decriminalization, Wood said, “The problem with it is that you still leave control of the market to organized crime. The user is not criminalized, but they still have to go to the black market.”

Yet, 20 years’ worth of evidence from Portugal show that paired with assertively promoting treatment and recovery, providing universal access to those programs and enforcing drug trafficking laws, decriminalization works.

There, it not only effectively brought an end to Portugal’s heroin overdose crisis, addiction and usage rates for all drugs including cigarettes and alcohol are now among the lowest in Europe.

dbramham@postmedia.com

Twitter: @bramham_daphne

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