A team of researchers working at a clinic in downtown Vancouver, British Columbia has added to the evidence behind advocacy for a safe, legal supply of opioids. It will come as no surprise to harm reductionists that opioid-dependent people with access to a regulated substance were found to be more likely to avoid overdose—and also to live less chaotic lives.
The substance provided in this case was the opioid hydromorphone (the generic version of the brand Dilaudid). The study, published in the journal Drug and Alcohol Dependence, included scientists from the Yale School of Medicine, the University of British Columbia and the British Columbia Centre on Substance Use.
Researchers observed and spoke with 42 participants at an overdose prevention center, which implemented a program in January 2019 to distribute free hydromorphone to people who had been using street opioids like heroin.
The program, housed at the Molson overdose prevention site, which is operated by the nonprofit Portland Hotel Society, now has 69 participants total. Each person can get up to 80 mg of prescribed hydromorphone each day, in 16 mg doses spaced at least one hour apart during office hours. They can get the drug in oral, nasal or injectable form. Nurses distribute the drugs and monitor patients’ use them, although take-home use has been allowed since the pandemic.
Participants told the researchers that the hydromorphone program reduced their need to “hustle,” engaging in activities such as theft, sex work and drug selling in order to afford drugs. They also felt safer getting drugs from the clinic, instead of being exposed to violence or police harassment on the streets.
“Nobody has to steal anymore,” said one male participant. “Nobody has to do that. You can satisfy your needs and do what you need to do without having to do anything illegal. I don’t have to steal. I don’t have to sell dope.”
Participants felt safer, too, in knowing exactly what drug they were taking and how much—which is impossible with the adulteration (particularly with fentanyl) and uncertain dosages of street supplies. This let them get the effects they needed while avoiding overdose and other harms.
“I don’t think anybody’s overdosing on the [safe supply] program,” said another male participant. “You know, there’s a standard of drugs that you know what you’re getting when you get this. Here, if you get it on the corner, you don’t know what you’re getting. You might think you do, but you don’t.”
The program allowed participants a measure of freedom in how and when they choose to use drugs. They could take as many or as few doses as they wanted each day, within the limits described. And importantly, if they stop coming to the program for any reason, they can return whenever they want without having to be put on a waitlist—as is typically required by methadone programs, for example.
But participants also noted plenty of room for improvement. The program doesn’t open until 1:30 pm, which means that many participants will still seek out illicit opioids like heroin in the morning to stave off withdrawal. The clinic housing the program would also lock its doors when responding to a drug overdose, which prevented some participants from getting their dose. Some participants additionally complained about sharing the building with other people who were using the illicit drugs they wanted to avoid, and about the quality of the generic hydromorphone versus the brand version.
The researchers wrote that similar programs could be replicated and scaled up in other cities and provinces with severe overdose rates. And they urged that for these safe supply programs to operate more effectively, the people who participate in them should help design how they operate.
Momentum for more safe supply programs is growing in Canada, which is struggling with rising drug overdose rates since the pandemic hit. Filter has reported on a project to install secure hydromorphone vending machines in downtown Vancouver, which has now served 3,500 doses since December.
In June, a group of protesters in the same area rallied outside and handed out free drugs that were bought off the street and checked for fentanyl with a spectrometer. The demonstration brought more attention to the need for a widely accessible, legal and safe drug supply.
Photograph via Portland Hotel Society.