Another record for monthly overdose deaths related to illicit drugs has been set in British Columbia, prompting the former provincial health officer to call for radical steps to reduce fatalities including access to pharmaceutical-grade heroin produced in Canada.
Dr. Perry Kendall, now interim director at the BC Centre on Substance Use, said access to injectable diacetylmorphine needs to be ramped up after a sharp rise in overdose deaths four years after he declared a public health emergency.
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The BC Coroners Service said Thursday that 175 fatalities in June surpassed the previous high of 171 deaths in May. There were 219 deaths in the first three months of 2016, when the emergency was declared.
About 5,000 people in British Columbia have died of illicit-drug overdoses since then.
Premier John Horgan said a national plan is needed to help stem the overdose crisis as he backed the Canadian Association of Chiefs of Police in calling for the possession of small amounts of illegal drugs to be decriminalized.
"So we take away the criminal stigma and focus on what this really is, a health-care crisis. We don't want people to be criminals, we want them to be patients and we want them to get well," he told a news conference in Victoria.
Diacetylmorphine has been used as an addiction treatment in some European countries for at least 20 years.
The Crosstown Clinic in Vancouver is the only facility in North America to prescribe the heroin substitute for people who have failed multiple times to treat their addiction, but the drug has been imported from Switzerland.
Kendall said 500 patients at the clinic are eligible for diacetylmorphine, which typically has about 120 patients on the treatment.
He is meeting with Health Canada officials next week to discuss importing the products that are needed, such as morphine, to domestically produce the drug.
The meeting is part his efforts to start a company with a doctor who led a landmark study in Vancouver, Montreal and Toronto between 2005 and 2008 that suggested diacetylmorphine is an effective treatment for severely addicted heroin users when methadone doesn't work.
Results released in 2016 from a second study showed similar results and included a pain medication called hydromorphone, which has been prescribed to opioid users during COVID-19 under a temporary federal exemption of drug laws because of an increasingly toxic supply of street drugs containing higher concentrations of fentanyl.
However, hydromorphone does not produce the same high that heroin users get and efforts to increase the number of people being treated on diacetylmorphine have been hampered by federal regulations as well as a lack of willingness by drug companies to produce it, Kendall said.
"It would seem that most of the commercial pharmaceutical companies are not interested in putting together the capacity to produce diacetylmorphine in Canada, I think because they think, frankly, the market isn't big enough to make it worthwhile for their investment."
Kendall said Dr. Martin Schechter, who was involved in the two landmark studies, approached him a year ago to work on a project to produce diacetylmorphine domestically as part of a not-for-profit society working with the University of British Columbia.
"We estimate we could produce diacetylmorphine in a formulation that would be far less expensive than that is currently available," Kendall said.
He also supports the decriminalization of small amounts of drugs for personal use.
Chief coroner Lisa Lapointe said the pandemic has made it more difficult to access harm-reduction services so many have ended up using drugs alone with no one to call for help or provide them with the overdose-reversing medication naloxone.
She said opioids, along with cocaine and the stimulants methamphetamine and amphetamine, have been detected among those who have fatally overdosed.
However, the illicit opioid fentanyl remains the most significant factor in the high number of deaths, with more people smoking the drug, Lapointe said.
"We're wondering whether they're thinking that smoking is safer than ingesting but it isn't, because the supply is so toxic," she said.
Officials say border closures have disrupted the usual flow of fentanyl into British Columbia and more toxic drugs are being produced locally by those who may be inexperienced.