How opioid vending machines could fix Vancouver's drug crisis - Macleans.ca
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How opioid vending machines could fix Vancouver’s drug crisis

Paul Wells: Overdoses killed 1,422 people in B.C. last year. For one doctor the solution is to “offer people the opportunity to get drugs that won’t kill them.”


 

Mark Tyndall, middle, Executive Medical Director of the BC Centre for Disease Control, helps volunteers respond to an overdose at the Overdose Prevention Society safe-injection site in the Downtown Eastside, Vancouver, British Columbia, Monday, January 15, 2018. (Photograph by Rafal Gerszak)

It took a long time for Dr. Mark Tyndall to decide that the best way to do his job would be to ensure Vancouverites could get hard drugs from automated vending machines.

Tyndall, 58, is the director of the British Columbia Centre for Disease Control. He’s been working with addicts for decades, helping them stay alive, helping them manage their addictions, helping those who think they might be ready—and on most days, that’s not a lot—try to get off drugs.

But lately he has grown weary of watching people die. Last year, overdoses killed 1,422 people in British Columbia, the highest number ever, a 43 per cent increase over 2016. It’s time for something radical, Tyndall thinks. “We need to offer people the opportunity to get drugs that won’t kill them,” he says.

And not a few people. More like hundreds or thousands. So sometime in the next several weeks, in March or April, Tyndall will launch a pilot program to distribute hydromorphone pills (a pharmaceutical narcotic derived from morphine) to registered users, using vending machines that read the distinctive blood-vessel patterns in a user’s finger to ensure they’re going to the right addict.

MORE: Facing the opioid crisis, an establishment doctor heads to the streets

The machines are distributed by Dispension Industries, a company in Halifax that gets them from American Green, a company in North Carolina. Perhaps not surprisingly, given the name of the U.S. company, the machines were originally designed to distribute cannabis, but rejigging them to dispense hydromorphone pills is easy enough.

“The media’s kind of run with this idea of vending machines,” Tyndall said ruefully. “It’s given a lot of people the idea that we’re going to put them in shopping malls, give them to children.” That is not the case. “It’s really more of an ATM than a vending machine. This is like a big metal box made of steel that can’t be taken anywhere. Biometrics [the blood-vessel-scanning technology] for access. It’ll tightly control how many pills you get out of it.” Tyndall is considering calling the gadgets “dispensing machines” rather than “vending machines,” in hopes of freaking out fewer people.

Vancouver’s Downtown Eastside, defined as a de facto colony for people who inject or smoke hard drugs, is smaller than it used to be—maybe half the 20 blocks it used to cover, with condo developments looming on all sides. On the warm January day when I visited, a lot of people are out, lining the sidewalks of East Hastings Street, a few side streets and many wide alleys off the main artery. Many are openly smoking or injecting drugs. It’s a shocking sight the first time you visit. You get used to it pretty quickly.

A user walks past a memorial as she arrives at Overdose Prevention Society safe-injection site in the Downtown Eastside, Vancouver, British Columbia, Monday, January 15, 2018. (Photograph by Rafal Gerszak)

One of the striking aspects of life in the Downtown Eastside is that because so many of its residents and social services have had so much practice, it is actually one of the safest places in Canada to have a drug overdose. The Insite supervised-consumption site has been open in the neighbourhood for more than a decade, Tyndall tells me in a café in the neighbourhood. Several less elaborate overdose-prevention sites, where users can take drugs at long tables and volunteers administer first aid if something goes awry, have opened more recently.

“There’s rapid access to methadone and suboxone,” used in treating narcotic addiction, Tyndall says. “A lot of people carry naloxone all over the place.” Naloxone blocks the effect of opioids, especially during an overdose. People here clip the little kits to their backpacks and take them everywhere. “There’s quite a bit of supportive housing. There are outreach nurses.”

READ: Can Ottawa stop Canada’s deadly opioid crisis?

The upshot is that if you’re using opioids in the Downtown Eastside and something goes wrong, you’re probably much closer to someone who can keep you from dying than you would be in most other places. Vancouver’s fire department reports that while one person dies for every 17 calls to the city’s 911 emergency line—and in South Vancouver it’s as high as one in five—in the Downtown Eastside, only one in 24 calls leads to a fatality.

But even when it’s survivable, an overdose is a harrowing experience with unpredictable outcomes. This point was driven home when I saw a man collapse from an overdose in front of me. Tyndall had taken me to visit one of the Overdose Prevention Society sites run by Sarah Blyth, a community organizer. Strictly speaking, the place operates outside the law. In reality, the police never bother it.

Tyndall hopes to put one of his dispensing machines in the back of Blyth’s centre this spring. Blyth was explaining the centre’s functioning to me when there was a thump at the plastic partition behind her. A man in his 50s using heroin at the end of one of the long steel tables had passed out and hit the partition on his way to the floor.

Volunteers at the centre, themselves addicts in most cases—they’re called peers, and they’re highly valued in places like this because addicts know how to spot an addict in distress—crouched over the man, whose name was Allan, and tried to coax him back to consciousness. No dice. He wasn’t breathing.

One volunteer called 911 while two more gave Allan oxygen and an injection of naloxone. By the time the ambulance attendants arrived, minutes later, Allan was awake and sitting upright on the floor. The attendants quizzed the volunteers about his treatment. “All right, good work,” one said after the briefing. They chatted with Allan briefly and left. He stayed sitting on the floor. They could have taken Allan to a hospital, Tyndall told me, but doctors could not have done more for him than Allan’s peers had done on-site, and he would have had to walk back to the Downtown Eastside. Most of the neighbourhood’s residents prefer to avoid the walk.

If Allan had been alone at home, an overdose of the kind I watched might have killed him or it might have spared him. It’s hard to guess. What’s known is that 90 per cent of overdose deaths in B.C. happen to people who are home alone. But Allan was at what everyone in the Downtown Eastside calls Sarah’s Place, so half an hour after he overdosed, he picked himself up and walked home.

READ: Born addicted to opioids

This was a catastrophe averted. But it’s hardly the best outcome. Tyndall says the Downtown Eastside is full of catastrophes averted, but it’s sorely in need of better outcomes.

“I can take you by the Crosstown clinic, which sees about 140 people every day for hydromorphone and heroin injections,” he says. Crosstown is the only place in Canada authorized by Health Canada to distribute free drugs to addicts. “The model’s been going on a long time. It’s very intensive and very expensive. And not really scalable.”

It’s also not the kind of life most users can accommodate. “Even if money was no object, most people don’t want to go into a medical establishment three times a day. The protocol is, you have to stay there for 45 minutes after injection. So that’s basically your whole life. It’s three times a day, and most people don’t travel far from the clinic. So they just mill around outside. So it’s just not practical for most people to do that.”

Tyndall’s plan is for the hydromorphone to be distributed to far more people with far less supervision. He has a $1.4-million, three-year Health Canada grant to test his machines. He doesn’t have final authorization to proceed, though he is talking to Health Canada officials nearly daily. That he has gotten this far is remarkable, because two successive federal Liberal health ministers, Jane Philpott and Ginette Petitpas Taylor, have said they wouldn’t contemplate expanding access to doctor-distributed drugs for addicts. That Ottawa is wavering on that line is a measure of the desperation the opioid crisis is causing.

Tyndall’s pilot project will distribute pills three times a day to between 200 and 300 carefully selected people. “If it worked, we could put these machines out quite quickly and scale it up.” He is aware the whole notion freaks people out.

Every time I write about opioids, I tell Tyndall, I hear from readers who say, “We went from giving addicts a place where they can safely use the drug, to just giving them the drug. We’re making it so easy for them. No wonder overdoses are skyrocketing. It’s paradise for drug users.”

Tyndall’s response: “That’s why people need to go to one person, meet one person [who uses opioids daily]. Tell me they’re living in paradise. I mean, it makes absolutely no sense. The people down here have gone through more hell than any of us could ever imagine.”

Addiction, he says, is a chronic relapsing disease. Most addicts don’t stop. Prohibition forces them to spend their day committing petty theft or prostitution or whatever else they need to do to pay for their next fix. And even then they don’t know whether their next fix will contain enough badly mixed carfentanyl to kill them. “You can’t ask people to recover if they’re dead. But the stigma goes so deep that I think a lot of people go, ‘Well, who gives a shit? They die. Better for us. We don’t have to pay their medical bills.’ ”

How can a medical doctor distribute clean drugs to addicts? To Tyndall, the question is why he wouldn’t, knowing that he is able to. “It’s not good enough for me to say, ‘Sorry, I have the drugs here that you need, but I’m not going to be able to prescribe them to you. You’ll have to go and find your own.’ I now have a lot of ethical problems with that.”

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How opioid vending machines could fix Vancouver’s drug crisis

  1. I see at the beginning of the story that not a lot of people want to stop drugs.
    WOW , the truth
    Usually it is told as “nobody wants to be an addict”.
    You mean nobody wants to go through the discomfort of withdrawal.
    “There’s quite a bit of supportive housing.” Social services.Outreach and like they said at the top help to get off their addiction “if they are ready”.
    It is amazing how when the story is promoting the efforts for injection sites and how they promote what they are doing that all these services magically appear.
    Yet when there is criticism toward gov’t efforts we must do more as services are non existent.The entire situation is then blamed on stigma while the truth is they are too scared to stop.
    DR. Tyndall and the B.C. center for disease control ,didn’t they recommend that drug dealers have access to mixing equipment and testing and a course in how to better prepare their products?
    Hundreds of toxic dumpsites being found in the Netherlands each year , maybe we can send hazardous materials disposal over to dealers labs to avoid the eco damage from their operations as well.
    I am sure the pilot project will have more than 100% success like all harm reduction strategies.
    So we see stories of even nurses stealing these type of pills and selling them for fentanyl and so large scale dispensing should help the addicts with a little bit of spending money for fentanyl.
    Of course these pills will be manufactured so that the dealers don’t replicate them on their pill presses once they become popular and “safe”.
    I mean didn’t oxy used to be “safe”
    Peer support , I bet they don’t sell drugs as I have seen one story where this is happening and so she took jail over rehab.Too scared to get clean as they can use in jail.
    Keep going Vancouver.
    Once there is another rash of overdoses then they will be administered only for use at the sites and so they will have what they always wanted .
    More supervised injection and they are willing to kill people to get it .
    This is a foot in the door technique for HAT.

  2. So, making weak drugs available to everyone is the answer eh?

    And when their addiction makes them want stronger drugs? What then?

    This is to drugs as guns in vending machines would be to the US.

    Does anyone think Trudeau is planning to collect the damning data along with the cherry picked positive stats when he unleashes marijuana on everyone this year?

    Who is going to hold his feet to the fire?

  3. SISs are a bad idea. They perpetuate the misery of the addict by giving up on them and expect that there is no help for them except to die an eventual early death. The 100% “positive” studies for SISs are unscientific at best, self-serving at worse. They increase public overdoses, public deaths, public use, needle litter, homelessness, crime.

    My arguments against SISs are in the comment section here:

    http://www.eastbaytimes.com/2017/09/07/supervised-injection-centers-california-weighs-controversial-law-to-fight-opioid-epidemic/

  4. We can also end all bank robberies by giving desperate people whatever money they want. The applications to this concept are endless. Scary that the person who proposed this is a doctor. Sure provides a lot of incentive to get free of drugs. If we have to take this kind of approach then have all addicts requesting free drugs confined to a remote area of the country. Provide treatment to all who want it and release anyone who doesn’t want to be there with no return allowed. Addicts off the street? Sure. Treatment for those who want it? Sure. Free drugs to keep them in a non-productive euphoric state? No way!

    • Shush, Jim! This is another trendy and edgy proggie utopian social experiment! What can possibly go wrong?

      • Why don’t we have “safe stealing sites?”

        Seriously. The government could rent a warehouse, then fill it with flat screen TV’s, late model SUV’s and ipads. Put a cheap lock on the doors. Encourage people to break in and steal it all.

        This will theoretically reduce the amount of car chases, violent arrests and not burden the justice system with arrested criminals.

        This faulty logic is no different than that used to justify free opiods.

  5. Let’s say you are boating in the middle of the ocean and find someone swimming from a shipwreck. If you throw them a life preserver, then boat off without rescuing them, you really haven’t done them a huge service.

    By analogy, if you provide an addict harm reduction, but don’t follow up with interventionist detox programs to break their addiction, you haven’t really done them a huge service either.

    Take a look at Vancouver’s Downtown Eastside. Despite millions of dollars of harm reduction spending millions a day, and it just keeps getting worse.

    Unless we are “intervening” in a manner that helps people permanently break addictions, we are not being compassionate, we are not helping and we are just burning up precious funds that could instead be used to give them their lives back.

    • Yes, It is like they are trying to convince people they are not seeing what they are seeing.
      Plus the media and the harm reduction activists are misrepresenting Portugal and Switzerland.
      Platzspits Park got so bad they had to send in police and backed up by riot police.Because they allowed a bubble zone of no arrest to grow.That is after they offered treatment .
      They dispersed so after more planning did a “repatriation” project so they built temporary jail at community center to hold them .Then sent them back to there place of origin to make them take methadone and work project.
      Portugal is better described as a displacement.
      They are not rich like Switzerland.They as well used extra police force and so to avoid being picked up they learn to stay out of the tourist and rich areas.
      Quote from Portugal 2001 implementation:
      In 2001 Vitalino Canas, the Portuguese state secretary “”Under the old system, the police turned a blind eye because it made no sense locking kids away when the prisons themselves were full of drugs” he said.
      “Now, the focus has shifted to getting people off the streets and into treatment, so the police are much more motivated.”
      The police still process people.
      The law is aimed at the country’s 30,000 heroin addicts
      “In Faro, the Algarve’s capital, stunned addicts are already feeling the effects of the new law. Used to being left alone by the police, they are now being hauled before the town’s anti-drug tribunal at a rate of two a day.”
      Elisabete Azevedo, the tribunal’s president, said the carrot-and-stick approach was backed by penalties ranging from loss of a driving licence to fines of up to £200. “If they accept treatment, they escape punishment.”
      Anyone found with more than 10 daily doses, however, will be treated as a dealer and face a long jail sentence.
      Quote from one of the many personal accounts that I have found:
      for what??- They just replaced heroin by methadone, nothing more.. and with no adequate control for each addicted drug!! .. Ive been in this kind of program since 2007 and only asked myself ONCE since then, how I felt, if I wanted to lower the dose or not … (it’s all for my account!) ..we continue to be treated not as persons, but as animals / I do not do any type of analysis, nothing ! (there is no treatment!)… . in 2000, they just try to clean the area which was known as Europe’s largest drug center, nothing else to build something, but still today (past 17 years) the neighborhood remains in ruins and among them you can always get someone who sells drugs.. it stayed the same; some drug dealer just moved the spot for sale drugs.. By the way, not always the government is willing to help, if we are late (because we have only 2 hours to go to take methadone, otherwise the door closes and ends up restocking methadone!) – which is much worse than the hangover of the heroine !…Its hard for workers as me sometimes to get on time but I often get knocked out buying methadone on the black market and if there is no methadone, I will have to pay 10 euros on heroin…so..”Good job is a strong word for it.

      • What drugs did you start with in your career as an addict?

        Do you still think drugs can be part of a successful life?

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