Could vending machines help solve B.C.'s opioid overdose crisis?

Public health official says distribution of clean drugs in pill form needed to reduce overdose deaths from the 'toxic' street drug supply.

Public health official says alternative to 'toxic' street drug supply would save lives

Dr. Mark Tyndall says oral hydromorphone for people with severe addictions is needed because "we really can’t tackle the overdose problem by trying to reduce the availability of prescription drugs." (Elizabeth Chiu/CBC)

A leading public health official suggests opioid vending machines could help solve British Columbia's drug overdose epidemic.

Dr. Mark Tyndall, the executive medical director of the BC Centre for Disease Control, said it's one way to get safe drugs into the hands of substance users who are dying in unprecedented numbers because the street drug supply has turned toxic.

"We really can't tackle the overdose problem by trying to reduce the availability of prescription drugs," Tyndall told On the Island host Gregor Craigie.

"There are many ways that we can do this. Probably the most extreme would be a vending machine," he said.

Tyndall suggested that vending machines could dispense eight-milligram Dilaudid pills, (a brand name for the opioid medication hydromorphone).

The pills are cheap, at a cost of 32 cents each. A typical user would crush, dissolve and inject the drug three times a day.

Access to the pills would be controlled through assessment of drug dependency and with limits on the number of pills dispensed each day.

Patient Mark Schnell gets his dose of hydromorphone from a booth before injecting it at Crosstown in Vancouver's Downtown Eastside. (Rafferty Baker/CBC)

While Tyndall acknowledged the public might not be ready for drug vending machines, he said distribution of clean drugs could start on a smaller scale.

For example, he said, Dilaudid could be distributed in pill form at a supportive housing facility that manages other medications, or at supervised consumption sites.

A step in that direction is a Health Canada-approved proposal to pilot models of oral hydromorphone distribution in Vancouver and Victoria.

The numbers of participants and launch date have not been established, and consultations are in progress about when and how to allow take-home drugs and other details.

A longtime heroin addict injects hydromorphone at the Crosstown Clinic in Vancouver's downtown eastside in the world's first clinical trial where substance users are provided with drugs and needles. (CBC)

Provincial guidelines for opioid addiction treatment recognize that not all users can tolerate or benefit from recommended replacement therapies with Suboxone or methadone.

In October, the B.C. Minister of Addictions and Mental Health, Judy Darcy, asked health authorities to scale up access to injectable hydromorphone for long-term substance users.  Supervised hydromorphone injections are currently available to a small number of long-time drug users at Vancouver's Crosstown Clinic.

Tyndall said the space, cost and staffing requirements mean the Crosstown model would not be able to reach the numbers of people who need it, even in the most optimistic scale-up scenario. 

About the Author

Deborah Wilson

CBC Victoria producer

Deborah Wilson is a journalist with CBC Radio in Victoria, B.C.