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Michael Mulligan: Prescription heroin could save lives

As of the end of November, 755 people had died of drug overdoses in B.C. Prescription heroin could greatly reduce this toll.

As of the end of November, 755 people had died of drug overdoses in B.C. Prescription heroin could greatly reduce this toll.

One of the principal reasons for the large number of overdose deaths has been the increasing presence of fentanyl, an opioid 100 times more powerful than heroin. Fentanyl is often substituted for, or added to, other illegal drugs.

A single envelope of pure fentanyl is enough to produce thousands of pills and tens of thousands of dollars in profit. One kilogram of fentanyl, which can be purchased online for less than $100,000, is enough to produce one million pills that can be sold for $20 each.

It’s unrealistic to think we are going to prevent such a concentrated substance from entering the country when there is an enormous profit motive. Experience has shown us we are not able to do so even with much less concentrated drugs.

Fentanyl overdoses occur because the original substance, or pills that are produced from it, are of varying strength. Because the substance is so potent, even a small variation in concentration can cause death. Because the substance is produced illegally, it is not subject to quality control — variations in the amount of the active ingredient is a certainty.

For people addicted to opioids such as heroin or fentanyl, daily existence typically involves the commission of property offences or the sale of their bodies in a desperate effort to secure enough money to purchase more drugs and avoid the pain of withdrawal. The impact of these activities, along with the corruption and criminal organizations they foster, are the costs we pay for our failed efforts to solve this problem.

Safe-consumption sites reduce the number of deaths by allowing antidotes to be administered more quickly when people overdose, and by providing clean needles to reduce disease transmission. As currently operated, however, they are a half measure.

The premise of a safe-consumption site is that people addicted to these substances bring their own drugs, of unknown strength, purchased with money often obtained by crime.

On Sept. 19, the federal government reinstated a program that permits doctors to apply for special access to prescribe pharmaceutical-grade heroin to people who are severely addicted.

The Special Access Program requires an application from a doctor or other medical practitioner for special permission to prescribe the drug where a patient has a serious or life-threatening condition, such as a serious opioid addiction, where other treatments have failed, are unsuitable or are unavailable.

Currently, Island Health staffs safe-consumption sites in Victoria with a paramedic, tasked with resuscitating people when they inevitably overdose on illegal drugs.

Island Health should also staff the consumption sites with a doctor to assess people and make applications, in suitable cases, for inclusion in the Special Access Program. Rather than administering naloxone to people overdosing on illegally obtained drugs, the paramedic could help with the applications and monitor the use of the legally obtained, safer, pharmaceutical-grade heroin.

This would save lives and reduce property crime caused by people attempting to obtain money to purchase dangerous drugs illegally.

Communities surrounding safe-consumption sites, operated in this way, would not have to deal with a concentration of drug trafficking and property crime.

The profit motive to import and manufacture dangerous illegal drugs would be reduced, as people provided with safer prescription drugs would no longer be buyers.

It would also reduce the sex trade, as this activity is also driven by people desperately trying to earn money to purchase drugs illegally.

Once people who are severely addicted are stabilized, and no longer spending their days trying to obtain drugs illegally, there would be an opportunity to encourage and provide detox and drug treatment.

Finally, operating safe-consumption sites in this way would be lawful. While the federal government has introduced legislation that will eventually make it easier to obtain permission to open safe-consumption sites where people consume illegally obtained drugs, this is not yet in place, and the sites in Victoria enjoy no exemption from federal drug legislation.

At least in theory, operating safe-consumption sites without such an exemption might amount to being a party to offences under the Controlled Drugs and Substances Act.


Michael T. Mulligan is a Victoria lawyer.

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