Workers on the front lines of Ottawa's opioid crisis say allowing drug users to consume drugs at supervised injection sites is not enough to prevent overdose deaths — so they are going one step further.
Ottawa Inner City Health began providing a small group of users with "clean" drugs in September following a rapid rise in the number of overdoses from street drugs contaminated with fentanyl over the summer.
"They're bringing in drugs that are laced with fentanyl, so the thought would be, if we're going to have supervised safe drug injection sites, why would we allow them to still inject poison?" said Dr. Jeff Turnbull, the chief physician for Ottawa Inner City Health, which provides health care to the homeless.
"Why would we not allow them to inject pharmaceutical-grade medications?"
Seven patients began receiving a combination of oral and intravenous doses of the painkiller hydromorphone, or Dilaudid, last month, and Turnbull wants to increase that to 40 users over the next month.
Turnbull said the number of overdoses in Ottawa was four cases a month in June. Now it has risen to four a day, he said.
"We've seen a dramatic change over the last three or four months," he said. "We've had many deaths. So our job right now, what we're struggling to do, is just keep people alive."
Targeting high-risk users
This is the first time outside of Vancouver, often seen as ground zero in Canada's opioid epidemic, that drug users have been given pharmaceutical-grade drugs to replace what they buy on the street.
The patients are given doses in an effort to stabilize their addiction.
The goal is for drug users to focus on other problems, such as mental health, and eventually lower the dose, or move to a methadone treatment program.
The new federal health minister, Ginette Petitpas Taylor, recently told CBC News she is working to make it easier for physicians to prescribe methadone, a synthetic opioid used to help people taper off their use of heroin and other opioids.
Turnbull said the patients he wants to have in his program would already have failed treatment programs using methadone or Suboxone, another drug used to treat opioid addiction.
"It would just be for those very select group of individuals who have failed those other treatment programs, and are at highest risk of death," he said.
The program isn't without hurdles, including a need for more staff and funding.
"Some of it we're paying for out of donations. We're just trying to scrape together whatever we can scrape together to make it happen," said Wendy Muckle, the executive director of Ottawa Inner City Health.
She estimates the cost to run the larger program for 40 drug users would be an estimated $400,000 annually.
Muckle has submitted a funding proposal to the local area health network.
"Our organization is in crisis because of this crisis. All available manpower, all available funding, all the resources are coming to deal with this," Muckle said. "The programs that are not directly involved in this are somewhat neglected right now."
Earlier this month, British Columbia released the province's first set of guidelines for prescribing injectable treatments for opioid addiction.
Turnbull is working with the College of Physicians and Surgeons of Ontario to create similar guidelines for the province.
"This is obviously new and it's challenging for all of us. It's not what I thought I would end up doing. But this is where I need to be to serve these individuals," he said.
Although Ottawa may be the first city outside of Vancouver to give opioids to drug users, Turnbull said other cities in Canada will shortly follow suit.
"Everybody is thinking about it," he said. "I can tell you there will be many other people not too far behind."