The safer provide program, which palms out high-doses of opioids and stimulants to guard drug customers, is about to lose federal funding.
Revealed Dec 30, 2024 • Final up to date 2 days in the past • 9 minute learn
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Respect RX and Restoration Care give out medical-grade opioids to about 500 individuals from a storefront on Rideau Road. Picture by JULIE OLIVER /POSTMEDIA
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4 years in the past, the opioid epidemic was delivered to the doorstep of Steve’s Music Retailer when an addictions clinic, Restoration Care, and a specialised pharmacy, Respect RX, opened subsequent door.
Each are a part of Ottawa’s experiment in safer provide – a program that sees lots of of people that use medication prescribed excessive doses of medical-grade opioids or stimulants to guard them from contaminated avenue medication.
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Steve’s Music Retailer supervisor Dan Sauvé says this system gave beginning to a “criminal ecosystem” that preyed on secure provide shoppers, and led to extra theft, drug dealing and unpredictable behaviour on Rideau Road. The shop locked its entrance door, and allowed clients in one after the other.
When the lease got here up for renewal final month, Steve’s house owners made the tough determination to maneuver from the Rideau Road location they’ve occupied for 42 years. The social chaos that got here with secure provide was the ultimate straw.
“To me,” Sauvé says, “the question is: How can we help people without causing so much collateral damage to neighbourhoods?”
Dan Sauvé, retailer supervisor. Steve’s Music Store is transferring from its Rideau Road location on the finish of the yr after 42 years due largely to the secure provide outlet that opened subsequent door. Picture by Jean Levac /POSTMEDIA
Delivered by a company referred to as Safer Provide Ottawa, the town’s four-year-old pilot program now serves about 500 individuals who use medication.
Its proponents contend this system saves lives, however with federal funding about to run out in March 2025, its future is in severe doubt: The Ontario authorities has made plain it doesn’t need something to do with safer provide.
“As far as I’m concerned the federal government is the biggest drug dealer in the entire country,” Premier Doug Ford charged earlier this yr. “It’s unacceptable, it needs to stop. We need to get rid of safe supply and put money into treatment and detox beds. That’s what we need to do, not continue to give people free drugs.”
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In November, the Ford authorities tabled a invoice, the Safer Streets, Stronger Communities Act, that can require municipalities to acquire provincial approval earlier than participating in a federally-funded safer provide program.
It has thrust safer provide, often known as prescribed alternate options, to the centre of a extremely polarized debate. Whereas Ford and different critics contend safer provide is a part of the issue – rising the general provide of opioids – others maintain it up as a life-saving a part of the answer: the easiest way to cut back the loss of life toll from poisonous avenue medication.
“The problem is the toxic drug crisis,” argues Donna Sarrazin, chief government officer of Restoration Care, an Ottawa agency that operates 5 drug therapy clinics within the area, and affords prescribing providers for Safer Provide Ottawa.
“Safer supply helps to keep individuals alive while also offering them additional supportive services and engagement opportunities. You can’t recover from addiction if you are dead.”
Safer Provide Ottawa was launched in July 2020 with a five-year, $9.6 million federal grant. Its mandate: to broaden the prescription of pharmaceutical opioids to drug customers who face the best threat of overdose and loss of life. The federal cash paid largely for added “wrap-around services” corresponding to major well being care, housing assist, case administration, counselling and psychological well being providers.
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Sarrazin insists the top of federal funding in March is not going to spell the top of this system since prepared docs and nurse practitioners will nonetheless be capable to prescribe opioids and stimulants to drug-addicted sufferers.
Ontario Works and the Ontario Incapacity Help Program cowl the price of most prescription drugs.
“At this time, there is no mechanism in place that prevents any prescriber from prescribing in this format,” says Sarrazin, program lead for Safer Provide Ottawa. “It’s unclear what changes the Ford government could or would make that could impact this ability.”
Hannah Jensen, director of communications for Well being Minister Sylvia Jones, didn’t reply to a query about whether or not safer provide prescribing is a matter for the Ford authorities.
It means the heated debate about the way forward for safer provide will proceed whilst key analysis questions stay unanswered.
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File picture from 2020: Donna Sarrazin and Mark Barnes, who function the secure provide program, which gives individuals with substance-use dysfunction with a secure provide of medication to allow them to get out of that day by day grind and hopefully get the remainder of their lives higher organized. Picture by Julie Oliver /POSTMEDIA
Safer Provide Ottawa was launched because the COVID-19 pandemic compounded the ache, isolation and threat confronted by drug customers, lots of them homeless. The pandemic’s journey restrictions additionally disrupted typical drug provide routes so Canadian cities have been flooded with medication concocted in basement chemical labs.
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In Ottawa, overdoses appeared in clusters, pushed by the toxicity of the brand new provide.
Safer provide was a hurt discount measure born of desperation: a option to save individuals from the harmful and unpredictable medication being offered on metropolis streets.
A coalition of frontline well being care companies got here collectively to handle this system: Pathways to Restoration, Restoration Care, Respect Rx Pharmacy, Ottawa Internal Metropolis Well being, Choices Bytown, Sandy Hill Neighborhood Well being Centre, Somerset West Neighborhood Well being Centre and Ottawa Public Well being.
Three of these companies, Restoration Care, Ottawa Internal Metropolis Well being, and Somerset West Neighborhood Well being Centre, provided prescribing providers.
The Ottawa Safer Provide program was designed with as “few barriers as possible” for customers. It affords versatile eligibility necessities and unobserved dosing, which suggests members can depart with their opioids or stimulants in hand to manage on their very own.
The method was designed to permit customers to medicate their drug cravings with out having to repeatedly return to a pharmacy.
Prescribers in this system usually supply shoppers short-acting hydromorphone (Dilaudid) tablets to manage drug cravings, together with a long-acting opioid corresponding to methadone or slow-release oral morphine. The medication are supposed to exchange fentanyl and its analogues.
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As much as 240 mg of day by day hydromorphone could be prescribed for every consumer. (Dilaudid’s producer, Purdue Pharma, recommends a day by day most dose of 18 mg for persistent ache.)
These within the safer stimulant program usually obtain short-acting methylphenidate, together with a long-acting model of the identical drug, or dextroamphetamine. The prescribed stimulants, generally used to deal with ADHD, are supposed to exchange avenue medication corresponding to crystal meth and crack cocaine.
In keeping with a just lately printed examine on Ottawa’s safer provide program carried out by College of Ottawa researchers, 70 per cent of these within the opioid substitute program mentioned they used much less fentanyl in the course of the four-month examine interval (Aug. 1 – Nov. 30, 2023). Amongst these receiving medical grade stimulants, 67 per cent reported utilizing much less from the unregulated drug market.
Amongst these receiving each safer opioids and stimulants, 66 per cent reported utilizing much less fentanyl and 63 per cent mentioned they used fewer stimulants.
Greater than three-quarters of all members (77 per cent) didn’t report a drug overdose in the course of the four-month examine interval.
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The examine was primarily based on self-reporting by shoppers.
On the time of the examine, 470 individuals have been enrolled within the safer provide program: 244 obtained medical-grade opioids, 36 obtained stimulants and 190 obtained each.
The examine, one in every of 4 that examined this system, doesn’t deal with some vital questions. Not one of the analysis research tracked what number of shoppers died, have been hospitalized, or pursued drug rehab in the course of the first 4 years of the safer provide program. There was additionally no management group for comparability functions.
As a part of the April 2023 examine, researchers requested a choose group of safer provide shoppers about diversion: the extent to which pharmaceuticals have been gifted, traded or offered to individuals outdoors this system. Most acknowledged that diversion did happen.
Some members instructed researchers that folks commerce Dilaudid for fentanyl as a result of the latter drug is stronger.
In a webinar, lead researcher Marlene Haines mentioned some members gave away medication due to concern for the well being of family members not in this system, or to assist pals going via withdrawal.
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“If we look at the culture of people who use drugs, they have always shared and have always taken care of one another, especially considering how rejected many of them feel and marginalized,” she mentioned.
Haines declined an interview request for this story. The Ottawa Police Service referred questions on diversion to Ottawa Public Heath, which in flip referred inquiries to Sarrazin.
Sarrazin concedes that diversion is a problem in safer provide, however she contends it’s a difficulty with all prescription providers, and with typical dependancy therapy, referred to as opioid agonist therapy. (It makes use of drugs corresponding to buprenorphine, methadone and Suboxone to deal with drug dependancy.)
“Diversion didn’t start with the introduction of prescribed alternatives,” she says.
British Columbia has essentially the most expertise with safer provide. In March 2020, B.C. rolled out the nation’s first province-wide safer provide program: It allowed docs and nurse practitioners to prescribe free pharmaceutical-grade opioids to individuals at excessive threat of overdose.
Earlier this yr, provincial well being officer Dr. Bonnie Henry issued a report on this system that referred to as for its enlargement to rural and distant communities, however the concept was rejected by the B.C. authorities. Greater than 4,300 individuals within the province obtain opioids and/ or stimulants beneath the present program.
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Vancouver Deputy Police Chief Fiona Wilson instructed a Commons committee in April that about 50 per cent of hydromorphone seizures within the province got here from safer provide diversions.
However there’s additionally some analysis that implies the B.C. program is saving lives. A examine printed early this yr within the British Medical Journal discovered individuals within the opioid safer provide program have been considerably much less prone to die within the week after filling an opioid prescription than customers who didn’t have entry to this system. The examine didn’t discover the identical profit for individuals receiving prescribed stimulants.
Safer provide is controversial even amongst docs who deal with individuals with addictions. Dr. Vincent Lam, a Toronto addictions specialist and writer who has written extensively concerning the opioid disaster, has mentioned he opposes safer provide as a result of, as a doctor, he’s dedicated to the moral precept ‘do no harm.’
Prescribing excessive doses of short-acting hydromorphone will increase particular person opioid tolerance ranges, he mentioned, whereas additionally including to the general provide of opioids on metropolis streets.
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“The more they (short-acting opioids) are used, the less effective they are, requiring ever higher doses, higher potencies, and entailing greater risks of overdose and death,” he wrote.
Most researchers hint the beginning of the present opioid epidemic to the late Nineteen Nineties when OxyContin was closely marketed by its producer, Purdue Pharma, and extensively prescribed to individuals seeking ache aid.
“Prescribed opioids were an integral part of the creation of this crisis,” Lam argued. “We are not going to be able to prescribe our way out of it.”
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Ottawa metropolis councillor Stéphanie Plante, in downtown Ottawa. Picture by JULIE OLIVER /POSTMEDIA
In Ottawa, there was no public reporting of the extent to which pharmaceuticals have been “diverted” onto the road, and to whom. Equally, there’s no understanding as as to if this system has decreased the general demand for fentanyl and different opioids.
What is understood is that the variety of confirmed overdose deaths has elevated in Ottawa in every of the previous 4 years.
Rideau-Vanier Coun. Stéphanie Plante, whose ward encompasses the ByWard Market and Sandy Hill, says she’s not against safer provide when prescribed opioids or stimulants are consumed in entrance of a health care provider or nurse. However she contends the present system is widening the town’s opioid epidemic.
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“I think this model is absolutely not working,” she says. “We find pill bottles all the time in my ward.”
Plante contends this system ought to have been intensively studied earlier than it was expanded. As an alternative, she says, this system moved forward with little or no analysis into draw back dangers, and with little or no session with native residents and companies.
Calla Barnett, chair of Motion Sandy Hill’s group and social providers committee, says she supported the concept of safer provide when it was first launched. However in the course of the previous 4 years, Barnett says, she has turn into satisfied this system is now a part of the issue.
“What it has meant is an increase in drug use,” she charged. “Dilaudid, hydromorphone have become a kind of currency. They’re tradeable for food or fentanyl.”
In early December, Ontario Auditor Normal Shelley Spence’s report on Ontario’s opioid technique referred to as it each outdated and ineffective. The report, amongst different issues, checked out using safer provide in Ontario.
Primarily based on its information evaluation, the workplace of the auditor common estimated that the safer provide allotting of hydromorphone in Ontario elevated by 251 per cent between 2019-20 and 2023-24. It now accounts for an estimated 686,000 hydromorphone doses allotted within the province.
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The auditor common famous the Ministry of Well being “has not taken any action to evaluate the extent of safer opioid supply’s adoption, as well as its effectiveness and outcomes.”
Spence beneficial the ministry conduct that analysis to permit for evidence-informed choices about this system’s future in Ontario.
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