The BC Centre for Disease Control issued a bold set of recommendations to address the province's unparalleled overdose crisis that includes providing drug users with clean opioids to take home and inject or allowing them to grow their own opium.
The recommendations, if adopted, would push British Columbia closer to essentially legalizing and regulating the use of drugs beyond marijuana – something many of the province's top drug policy and public-health experts have called for. It has taken on a new urgency, they say, with fentanyl's domination of the illicit drug supply, which has led to a dramatic surge in overdose deaths.
The federal government has emphasized there are no plans to review other drugs beyond marijuana. However, B.C. does have some leeway in prescribing drugs off-label – especially during a public-health emergency.
Mark Tyndall, executive medical director for the BCCDC, described the current approach to addiction treatment as backwards.
"We strongly advise people to stop using street drugs, and if they can't do that, then we offer them … Suboxone or methadone, and if that doesn't work, we basically tell them to go and find their own drugs even though there is a very real possibility of dying," he said.
"What we should be doing – especially in an environment of a poisoned drug supply – is to start with access to uncontaminated drugs so at least people don't die, then move on to substitution therapy and eventually recovery."
The recommendations, grouped into 10 "areas of action," were developed in consultation with stakeholders including public health leaders, policy makers and people with lived experience, who met for the second Overdose Action Exchange in Vancouver last June. They were released Wednesday in a 20-page report.
Providing pharmaceutical-grade opioids could mean expanding access to supervised injectable opioid-assisted treatment with heroin or hydromorphone, which already happens on a small scale in B.C.
However, the new recommendations also propose dispensing oral hydromorphone that drug users could take home, grind up and inject without supervision.
"If our objective is to give people access to non-toxic drugs, then diversion isn't necessarily a bad thing," Dr. Tyndall said.
However, he acknowledged this will be difficult for some to accept – "including doctors, who have been given the total opposite message that they have caused this problem and they have to stop prescribing these things."
The report also recommends exploring medical opium as a source of uncontaminated opioids, with grower's clubs and production on a model similar to the personal cultivation of medical marijuana.
Another recommendation is to expand drug-checking services – not just for drug users to check their drugs for fentanyl and other additives, but for drug producers to ensure a level of quality in their product. There are a few government-funded labs in the Netherlands, for example, where anyone can get their drugs tested.
"I'm still firmly of the belief that nobody's actually trying to kill people," Dr. Tyndall said. "These manufacturers don't know what they're doing and they're putting out ridiculous concentrations of these drugs. It would be an experiment, but I think it would be very interesting to see the uptake of that."
Another recommendation is to strike a provincial coalition to "build B.C.'s vision of drug law reform." An initial goal would be decriminalization and a longer-term goal would be full legalization and regulation, which "is necessary to address contamination of the drug supply," the report says.
Other recommendations include expanding and improving addiction treatment, developing incentives to encourage physicians take addictions training and aligning law enforcement efforts with public health.
Judy Darcy, B.C.'s Minister for Mental Health and Addictions, was not available for an interview about the recommendations on Wednesday. In a statement, she said her ministry will be reviewing the recommendations.
Asked about decriminalization at an update on overdose deaths earlier this month, Ms. Darcy said the federal government is not contemplating it and there are other things B.C. can do in the present context.
British Columbia is on pace to lose more than 1,500 people to drug overdoses this year, compared to an annual average of about 200 from 2000 through 2010.
Fentanyl has been detected in 78 per cent of overdose deaths so far this year, up from 67 per cent last year, and almost 90 per cent of such deaths are occurring indoors.