It doesn’t appear likely that the city will see any initiatives to take on prescription heroin anytime soon, just over a year after Abbotsford’s first publicly funded opioid replacement therapy clinic opened its doors.
In the spring, the federal government began allowing doctors and nurse practitioners to prescribe diacetylmorphine (heroin) without having to apply for a Health Canada exemption to import the substance from the manufacturer in Switzerland.
Collectively with injectable hydromorphone, prescription diacetylmorphine is referred to as injectable opioid agonist therapy (iOAT), and currently there are no clinics providing that service in Abbotsford.
“At this time, we don’t have plans to implement injectable opioid agonist therapy treatment in Abbotsford,” said Fraser Health spokesperson Jacqueline Blackwell.
But the idea is beginning to gain some traction in B.C. According to a recent B.C. Centre on Substance Use report, 21 physicians and two nurse practitioners are now able to prescribe the treatment in the province, while 172 physicians, nurses, pharmacists and specialists, have completed an online training module since last December.
BCCSU spokesperson Kevin Hollet says 21 of the health-care providers who have undergone the online course are from the Fraser Health region, but could not say whether any of those individuals were in Abbotsford.
The OAT Centre, Abbotsford’s only publicly funded opioid agonist therapy clinic, celebrated its first anniversary in November, and program co-ordinator Lesley Braithwaite says the clinic has greatly improved access to the treatment in Abbotsford. Before the OAT Centre came along, patients would have to pay at private clinics or go out of town.
Braithwaite notes the underlying issues that ultimately tend to be some of the most important factors in opioid addictions, such as poverty, unstable or nonexistent housing, mental health issues and trauma. But finding housing or a job and going to counselling requires stability in one’s life.
OAT treatments are successful, Braithwaite says, because suboxone and methadone offer that stability in the clients’ lives. No longer must they engage in drug seeking behaviours with methadone or suboxone taking care of withdrawal symptoms.
But Braithwaite says the iOAT treatments could make treatment more successful. Having a safe supply of hydromorphone or diacetylmorphine would mean even less chance of relapsing onto dangerous street drugs, providing stability for those not yet ready for suboxone or methadone.
“It stops the pain. … That’s what the research shows. Pain is pain. Same region in the brain the lights up whether you’re in emotional pain or physical pain, and it stops the pain,” Braithwaite said.
“People can’t get off of what they’re addicted to unless they have a reason to.”
A key to success in replacement therapies is the mental health support worker, Jennica Gill, who helps clients find work or housing, get to appointments or pick up prescriptions.
“It’s a proven fact that when you’re on suboxone or methadone treatment, when you’re accessing other resources like counselling or finding work, whatever it may be, you have a higher chance of being successful in your treatment,” Gill said.
While doctors can still be hesitant to prescribe OAT treatments, Gill says it is becoming more normalized in the health-care community.
“I’ve just seen a lot of involvement from the younger generation of doctors, for sure,” Gill said, adding that social pressures can be a barrier to clients.
“We actually have clients who, especially in the Indo-Canadian side of town, actually rather go on the other side of town to go pick up their methadone or suboxone because of the stigma.”
Despite the stigma, the opioid crisis has been pervasive. No longer confined to marginalized communities like the Downtown Eastside, the crisis has been a catalyst for a change in how addictions are viewed, Braithwaite says, leading to expanding health-based services like injectable opioid treatments.
“Everybody is having people that they know, that they never dreamed would do drugs, dying of overdoses,” Braithwaite said. “It’s just happening in such numbers, now, that it’s hard not to take it pretty seriously.”