Deb Bailey's daughter "Izzy" could order heroin like pizza but struggled to get Suboxone, an opiate-blocker often prescribed with restrictions — restrictions that may have played a key role in her fentanyl overdose this Christmas.
"A drug dealer will deliver drugs to your door in 5 minutes. It's easier than getting pizza. Yet we make the treatment for people much more difficult to get," said the 21-year-old's mother.
"I always told Izzy that if anybody could beat addiction it was her." - Deb Bailey, mother of a fentanyl overdose victim.
Bailey says her daughter — born Elyse Ola Mary — but known to most as "Izzy," would not have been using street drugs if she had easier access to the drug that stopped her cravings for heroin and prevented withdrawal symptoms.
Izzy was required to physically go to a pharmacy and prove she had swallowed her Suboxone.
The restrictions on Suboxone are at the centre of a heated debate among addiction doctors concerned about an alarming, ten-fold spike in fentanyl-related overdoses since 2012.
The pill is a combination of buprenorphine and naloxone, a drug that when injected counters the effect of narcotics, making it six times safer than methadone, according to studies.
'Trying to keep this kid alive'
B.C.'s College of Physicians and Surgeons recommends "daily witnessed ingestion (DWI) for the first two months" or until the patient is stable, but Bailey said that is "unrealistic."
"We expect them to be organized. To be able to get down to the drug store. To enter the pharmacy. Well the pull of addiction is much stronger than all of those things," said Bailey.
- Chronology: A timeline of Izzy Bailey's life
- Wasted: A documentary about evidence-based addiction treatment on CBC's The Nature of Things
Bailey said she pleaded with her daughter's addiction physician-specialist to allow her and her husband "carry" Izzy's pills home because daily pharmacy visits were humiliating.
"I said to him, 'I'm just trying to keep this kid alive'... You know that she's overdosed before," Bailey said.
The doctor "shrugged" and refused, and Izzy returned to heroin, she added.
Izzy went Christmas shopping Dec. 22 and never returned.
Izzy's mother believes her daughter tried to buy heroin the day she died — but got fentanyl instead.
The 21-year-old was found in the stairwell of a building on Hastings street on Vancouver's Downtown Eastside.
Her phone, wallet and bag were stolen.
A naloxone kit with opioid antidote that might have saved Izzy was available at the building entrance just metres away.
"We're losing the battle here," said Bailey, after reviewing surveillance video of her daughter exchange money for what she believes was fake heroin, before she disappeared down a hall.
Izzy was one of four addicts to die that week. Seventeen more were treated for fentanyl overdose.
The former hockey player who'd earned her black belt was open with her family about her addiction and her desire to get back on Suboxone.
She had successfully abstained from street drugs while taking it after surgery.
Ten-fold rise in fentanyl-related death
The restrictions on Suboxone have sparked debate among addiction doctors, pointing to the need to act in the face of a ten-fold spike in fentanyl-related overdoses since 2012.
According to the B.C. Coroner's Service, Izzy is one of an estimated 139 people to die of fentanyl related overdose in 2015.
"The escalation in fentanyl overdose deaths is a public health tragedy but not every single one of those deaths is a death that could have been prevented by Suboxone or methadone." said Dr. Ailve McNestry, deputy registrar of the College of Physicians and Surgeons of British Columbia.
Unlike Alberta, Manitoba, Ontario, Quebec and Nova Scotia, B.C. only allows doctors with special methadone training to prescribe Suboxone.
"The education requirements for Suboxone shouldn't be any less than the education requirements for methadone," said McNestry.
But several addiction specialists strongly disagree.
"Suboxone has better safety profile than methadone, and there really is no need to regulate it and [regulate it] more than a doctor prescribing insulin to a diabetic," Dr. Seonaid Nolan, a research scientist who treats addicts at St. Paul's Hospital told CBC.
73 physicians call for changes
"I was fortunate enough to spend a month in Boston where take-home Suboxone is done all the time. It definitely removes the stigma of having to present to the pharmacy and interrupt your daily life."
Nolan is one of 73 physicians who signed a report urging the college to allow all doctors to prescribe Suboxone to B.C's growing population of opioid abusers.
The report says B.C.'s restrictions are unnecessary and harmful to addicts, who have no way of knowing what they are ingesting.
"They think they are buying regular heroin when what they are actually ingesting is fentanyl, which is so much more potent and dangerous."
Health minister impatient
"We are reviewing our whole methadone and Suboxone program," said Terry Lake, B.C.'s health minister, who is urging the college to make Suboxone more accessible.
"I'm surprised they haven't moved more quickly on this."
"Is the witnessing really necessary?" Lake said, concerned about the cost of potentially unnecessary daily dispensing fees.
"I think it's important to react quickly because we can save lives, so we will be having an ongoing discussion with the college to try to increase the accessibility of the availability of Suboxone."
McNestry said the guidelines do not force doctors to prescribe witnessed ingestion.
"Any physician who wants to give a take-home dose of Suboxone to a patient they consider stable is free to do that."
A panel of experts will review the Suboxone guidelines next month, McNestry added.