New Ottawa initiative will allow homeless drug users to inject prescription opioids
Managed opioid program designed to reduce risk from fentanyl-laced street drugs
Ottawa will soon become the second Canadian city to have a managed opioid program in place for homeless people trying to kick their drug addictions.
Ottawa Inner City Health (OICH) is in the midst of setting up the program, which will initially allow people with addictions to take prescribed opioids under a doctor's supervision at local shelters — rather than risking their lives with street drugs.
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"When people buy [drugs] off the street, first of all, they don't really know the dose," said Wendy Muckle, the agency's executive director.
"And secondly, we have a huge problem with fentanyl being laced in everything … People don't know when they get it and how much they are getting."
Vancouver only other Canadian site
The opiate to be used for the substitution is called hydromorphone, also known as Dilaudid, and can be administered orally or by injection.
Right now, Vancouver is believed to be the only place in Canada with a similar program, although that city's Crosstown Clinic in the Downtown Eastside allows drug users to inject prescription heroin rather than a substitute.
While managed heroin is used both in B.C. and in Europe, Muckle said research has shown that hydromorphone provides the same effects for opioid users — and comes with a lot less regulatory hassle.
"Heroin's a bit problematic in Canada. It's expensive, you have to import it, there are a lot of restrictions around it," said Muckle.
"Dilaudid is something that we currently prescribe anyways. It's legal. It's cheap."
Outside the Shepherds of Good Hope's Murray Street shelter, Jeannie Lee Parsons said she'd be willing to see if a managed opioid program could help her kick her own addiction to street drugs like heroin.
"I almost died of fentanyl last month. I almost OD'd, and my roommate saved my life with a naloxone spray," said Lee Parsons.
"Life's too short. Why make it shorter?"
Not a supervised injection site
The OICH program is being crafted at the same time that the Sandy Hill Community Health Centre is preparing to open Ottawa's first supervised drug injection site.
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The community centre has proposed a facility that would provide supervised injections to between 80 and 150 people a day, many of whom already use the centre for other reasons. It received an exemption from Health Canada last month.
OICH is also applying for its own exemption for a supervised injection site. The main difference between those sites and managed opioid programs is that the former requires Health Canada's approval, while the latter — because a medical professional is prescribing perfectly legal drugs — does not.
"Because the substances that people will be injecting or consuming are not illegal, we don't need an exemption. An exemption allows people to use pre-obtained drugs," Muckle said.
How it works
Participants in Ottawa's managed opioid program would first get a hydromorphone prescription based on what drugs they are already using. They would then show up at the clinic and administer the drugs themselves "in the way that they're intended to be administered," Muckle said.
Muckle said one hope is that once drug users begin taking part in the program, they'll recommend it to other people on the streets.
"This is not an exclusive club. We're trying to meet the need in the community," she said.
"We would like for people in the homeless community to not be buying drugs off the street and not be at such high risk of overdose."
Ottawa Public Health said in a statement that they support the OICH program, as well as other "enhanced harm reduction services." In an email, the Ottawa Police Service said it would not comment on the program until they had "more information" about it.
Ottawa Inner City Health hopes to begin distributing hydropmorphone by September.