B.C. gives up on its [opiate] addicts and will just keep them on Hydromorphone

[Chip (OP)]

source: http://nationalpost.com/opinion/b-c-gives-up-on-its-addicts-and-decides-to-just-keep-them-on-drugs

B.C. gives up on its addicts and decides to just keep them on drugs [February 14, 2018]



A woman injects hydromorphone at the Providence Health Care Crosstown Clinic in the Downtown Eastside of Vancouver, B.C., on April 6, 2016

The British Columbia public health authorities are making a huge mistake. The province is advancing a series of reckless interventions that are counterproductive in fighting the opioid epidemic. If B.C. continues in this manner, the province is destined to remain in a state of perpetual opioid addiction.

Ottawa recently granted approval of a B.C. pilot to distribute high-dose hydromorphone, a potent opioid, three times daily at supportive housing units and supervised injection sites. Drug users are free to use the hydromorphone as they please; authorities anticipate many will crush and inject the opioids to intensify their high. Moreover, the province has plans to grant “qualified” opioid users biometric access to vending machines of hydromorphone for drug users’ convenient consumption.

Proponents argue that providing a readily accessible supply of “clean opioids” is necessary to reduce overdose deaths in an environment contaminated by fentanyl. The program’s architect, Dr. Mark Tyndall, executive director of the British Columbia Centre for Disease Control, admits that installing opioid vending machines isn’t treatment but suggests there will be an ensuing transition to “substitution therapy and eventually recovery.”

By what means will the individual be delivered from the chains of addiction if high-dose opioids are so readily available?

But this plan of “eventual recovery” is vague and undefined. By what means will the individual be delivered from the chains of addiction if high-dose opioids are so readily available?

According to B.C. addiction philosophy, opioids, if medically administered, can have a positive “stabilizing” effect on the active drug user because that eliminates the desperate struggle inherent in habitual drug use. For this reason, the province is actively expanding access to both heroin-assisted-treatment and the dispensing of morphine for dependent opioid users. The province has imported expensive pharmaceutical-grade heroin from Switzerland specifically for this treatment. The theory is that the drug user who has a regular supply of safe opioids administered under the auspices of the medical system will be in a good position to begin their risk-free progression toward recovery.

But this plan lacks common sense.



Proponents argue that providing a readily accessible supply of “clean opioids,” such as the hydromorphone pills pictured, is necessary to reduce overdose deaths among drug addicts.

The notion is completely at odds with the lived experience of many former severely addicted opioid users who were able to free themselves from chemical dependence only after a long and bitter battle.

Herein lies the crux of the problem with the B.C model: it enables drug use seemingly without end or consequence. The system places all its resources into attempting to “stabilize” an intrinsically unstable and harmful activity. The B.C. notion of recovery is so compromised that one can scarcely differentiate addiction treatment from active drug use.

Why not instead capitalize on the wisdom of those who have overcome the illness?

Since 2010, the Rhode Island government has funded Anchor Recovery, a program formed exclusively by past opioid addicts. Termed “recovery coaches,” these individuals connect with active drug users in the streets and in shelters; they meet patients as they recover in the emergency department after an overdose. Having lived on the streets and spent time in prison or in hospital, these individuals understand the challenges of drug use. Their very existence serves as an encouraging reminder that a life free from narcotics is possible.

Instead of listening to those who have recovered from addiction, the province is doing just the opposite. Drug policy is directly informed by a number of active drug-user advocacy groups. Released in August 2017, the BC Overdose Action Exchange II Meeting Report was written in partnership with the Canadian Association of People Who Use Drugs (CAPUD), the Vancouver Area Network of Drug Users, and the Society of Living Illicit Drug Users. It was this document that first called for the expansion of freely available hydromorphone.

It is unclear to what extent members of these organizations view their own drug use as problematic. Jordan Westfall, president of CAPUD, argues that B.C.’s hydromorphone distribution intervention contains “no misguided attempts at ‘fixing’ the human being.” He states: “I’m not recovering from drug addiction; I’m recovering from bad drug policy.” This frank denial of individual pathology in addiction, or of any need to take responsibility for one’s conduct, is representative of B.C.’s dangerously flawed approach.

Both the criminal justice system and medicine are limited. Neither can artificially provide a reason to stay sober. To a real extent, these are questions to be worked out by the individual. This enormous challenge can be facilitated by those who have conquered their addiction.

The government should take the millions of dollars it intends to spend on hydromorphone and heroin and instead redirect those dollars towards a blitz of Anchor-style recovery programs. This would offer a two-fold benefit: It would provide both a source of meaningful work (which solidifies sobriety), and would encourage other drug users to do the same.

[dillydudeEL14]

This is so fucking amazingly awesome I can’t even believe it haha. Fuck the people who wrote this who are clearly against it tho. Oh how I would love that I mean I get dilaudid scripted now( as I’m sure everyone knows since I couldn’t stop talking about it for like a week) but I wish I could get it in that type of setting where it was understood that I needed it tosatisfy my addiction and not have to do the whole pain management thing.

I understand the position of the writer of this article but they just don’t understand that many people will just continue to use street shit if they aren’t provided clean opioids. Yes there probably is a certain percentage of people who would make the effort to get clean if this wasn’t an option, but I firmly believe that this program does more good than harm many times over. If someone really wants to get clean they will still want to even if dilaudid and heroin is available. I can’t back this up but I have a theory that this program may even lead some people to get “bored “ with using since it’s so easy and eventually they may say “you know what, fuck this I’m done coming here every day to stick a needle in my arm and now I’m gonna stop”. Like I feel like this could make using really monotonous without the ups and downs of using getting sick and hustling money and scoring. I have kind of noticed this in myself since I have had dilaudid for the past few months, but I’m def not ready to stop yet tho.

Ive never seen those ds they had pictured. 1mg ds? Never seen those. Also I wonder why they don’t provide dilaudid In injection form. Ain’t nobody there using ds any other way than Iv you know that !

[nurse_K]

I do not understand the headline. As I read it it is not so much a question of giving up... its giving hope and saving lives. I cannot read however that there are health-professionals and social workers available for the users of the site.

I have worked for years in a heroin clinic. My experience is that after some time ( stabilization fase ) users start to focus on other aspects in life as they now have the mental energy to do so. But stabilization is crucial and should not be underestimated.

[LadyKalma]

I love this projects existance. Hopefully time will show the haters that itll reduce public health money being spent on addicts cause theyll be healthier and stable and less overdoses. And less new users coming up cause the current ones wont have to sell drugs to pay for their habits.

Unfortunately its not a position that's easy to explain to non users. But giving people stability and ability to decide to recover when ready is such a good plan. I wonder if Americans are allowed on this program? Im going to find out, cause om sure as hell not holding my breath till something good happens here.

[hanna]

This is amazing!

BC should be applauded for this intelligent approach to addiction.

First, there are folks who will never seek to stop their drug use. Now, these folks shouldn't have any reason for committing crimes to get money for drugs. Nor will they clog ER units from overdoses, the court system for possession, prisons for sentences. The positive benefit to society is incredible!

Second, for those who want to get clean the hustle is no longer the reason the day comes and goes without them doing something productive with their lives. Now they can wake, make a positive choice about the day, and actually move one foot forward! With enough days like this they might find employment they like, maybe even volunteer work, return to school, and if they are parents they can focus completely on their kids! Again the value to society here is incredible but the value to the individual moving ahead in life is phenomenal

It seems the only ones that won't be helped are the hardheads that always want to get a little higher, the reclusive people who don't want to interact with modern society, the ones who get their rush doing crimes to fund their addiction. I have no problem dealing out long and harsh sentences to those who insist on attacking society when so much is being done to provide help for them.

[traplord69]

I pray that something like this happens in the states eventually.  Like others have said though it seems completely counter-intuitive and insane to people that have no experience with or knowledge of addiction. To boil it down as simply as possible, the vast majority of opiate addicts will continue using until a) they're dead b) they are forced to stop (intervention/rehab, jail, etc) which often doesn't work, or lastly c) they themselves finally decide that they are sick/bored/tired of it and decide to stop.  A program like this would essentially eliminate a and b, allowing addicts to avoid dying or winding up in jail because of their habit, and in their own time arrive at the last option. 

There are so many other benefits of something like this as well which have been discussed in this forum and elsewhere where similar programs exist.  Even in countries like Portugal where drugs are decriminalized they are pretty much taking a half measure, don't get me wrong I'd take decriminalization any day. But, although I'm sure their government pursues drug trafficer's more vigilantly, why not take away all of their power and just manufacture, regulate, and legalize these drugs.  By not doing so we allow a multi billion dollar and one of the most violent businesses's to continue operating and profiting off of the countries addiction.  It's just sad that we are where we are because of terribly outdated policy and opinions that have zero scientific basis.  And lets not forget about the other multi billion dollar industry which is the failed war on drugs and our prison systems, both of which obviously count on our current drug laws to remain afloat.  It's just so fucked up at this point atleast in the US that I just don't see a clear way out of it.  I just can't imagine a politician or presidential candidate saying "you know what, the war on drugs is lost, it failed miserably and we have to find a completely new way forward".  We would get a lot more accomplished if people could just admit that they fucked up on something, take responsibility for it, and find a better way to go about it