April 25, 2020

New pandemic guidelines giving medical professionals and pharmacists flexibility to prescribe and distribute drugs to those suffering from addiction need to be put into practice more quickly in order to keep everyone safe, say advocates.

THE ALREADY-TOXIC STREET DRUG SUPPLY in BC is becoming increasingly poisonous and expensive as borders close and supplies from China and the US shrink.

But, for most people suffering from addiction, quitting is not an immediate option and, although a growing amount of basement concoctions are being sold on the street, the urge to avoid withdrawal overrides all else.

“You will have to go out, no matter what, and do what you have to do to get that substance,” said Guy Felicella, who spent decades as a heroin addict living in Vancouver’s Downtown Eastside and is now clean, an advocate for a safe drug supply and a peer clinical adviser for BC Centre on Substance Use.

Guy Felicella, right, an advocate for a safe drug supply (Photo courtesy guyfelicella.com)

As COVID-19 physical distancing rules clear the streets, it is more difficult to make money from panhandling, bottle collecting or the sex trade. Advocates worry that people with addictions are struggling to find alternate ways to finance their habits.

There is also concern that those searching for drugs are at risk of both contracting and spreading COVID-19.

So it is to everyone’s advantage that new guidelines will give prescribers and pharmacists flexibility to prescribe and distribute drugs such as hydromorphone, stimulants, benzodiazepines, and substances to manage alcohol and nicotine withdrawal, according to Felicella and other advocates.

Federal relaxation of the Controlled Drugs and Substances Act was followed last month by innovative provincial guidelines designed to address two overlapping public health emergencies—the opioid crisis, fuelled by fentanyl, which has killed more than 5,000 British Columbians since January 2016 and, now, COVID-19.

The new rules allow physicians and nurse practitioners to prescribe the drugs to people at risk of contracting COVID-19, those with a history of ongoing substance use, people at high risk of withdrawal or overdose and youth under the age of 19 who provide informed consent, provided there is additional education. Costs are covered by provincial PharmaCare.

Rapid access addiction clinics can also provide assessments, and phone visits to prescribers and pharmacists are encouraged. The guidelines allow home delivery by pharmacy employees, pharmacists can extend, renew and transfer prescriptions and, in some cases, people will be allowed up to three weeks supply instead of having to go to the pharmacy daily.

“We want people not to have to go into pharmacies every day, which puts themselves and other people at risk when they should be self-isolating,” said Judy Darcy, Minister of Mental health and Addiction. “We are trying to flatten the curve at the same time as stopping overdoses and these really unprecedented measures are meant to do both of those things,” she said.

The guidelines were put in place as fast as possible and a massive effort is now underway to get the word out to all health professionals, Darcy said.

However, implementation is slow as some physicians and pharmacists are not yet fully informed about the changes.

It is frustrating, said Leslie McBain, co-founder of Moms Stop The Harm. “What you had was rollout of a good policy that I hope will continue to progress and evolve, but the infrastructure was not out there,” McBain said.

She added, “If I was a person searching for safe drugs because I didn’t want to go out and buy them on the street, there was no way to figure out that pathway.”

Bernie Pauly, University of Victoria School of Nursing professor and a scientist with the Canadian Institute for Substance Use research, said it is essential prescribers familiarize themselves with the changes. “[They] need to not only know and understand the guidelines, they need to do it really quickly because people’s lives are at stake,” she said.

Pauly and other advocates are anxious to ensure the changes stay in place after federal exemptions reach their sunset clause at the end of September.

“I would hope we are able to show the benefits of this,” said Pauly, who also wants to see decriminalization of personal possession—something recommended last year by provincial health officer Dr Bonnie Henry.

Felicella wants to see a further step with pharmaceutical grade heroin, fentanyl and cocaine made available without prescription.

“What we have today is a medical version and it’s a great start and will help many people, but it is not where we want to stay,” he said.

Judith Lavoie is an award-winning journalist specializing in the environment, First Nations, and social issues. Twitter @LavoieJudith