An influential drug expert group in western Canada has proposed allowing people to access a legally regulated heroin supply, in a bid to reduce overdoses and fight organised crime.

In a new report, the British Columbia Centre on Substance Use (BCCSU) has proposed the creation of members-only clubs where patients can legally acquire pharmaceutically-produced heroin. This approach would reduce the likelihood of someone unwittingly consuming heroin containing fentanyl – a powerful opioid to which soaring overdose rates have been attributed – and would simultaneously undermine organised criminal groups by discouraging people from buying heroin illegally.

BCCSU argue that this measure is urgently needed in their province due to the ongoing public health crisis. In 2018, there were almost 1,500 reported overdoses in British Columbia – roughly 260 such deaths per one million population; more than three times higher than the Canadian average of 81 overdose deaths per million. Of these 1,500, a staggering 85 per cent involved illicit fentanyl. This suggests that access to a regulated heroin supply without fentanyl could vastly reduce deaths.

The club would work as a “member-driven purchasing cooperative”, meaning members would combine their resources to acquire the heroin in bulk at a lower price from suppliers. BCCSU suggests that it be operated by a non-profit organisation involving experts with relevant lived experience.

To prevent diversion to the illegal market, the club would limit quantities provided to “what might be expected for individual, short-term personal use”.

Clubs would be established alongside other harm reduction and treatment services, so that people who sought help for their drug use could freely and easily access it. Furthermore, the approach would improve harm reduction outcomes by requiring members to complete overdose prevention and training with naloxone – an overdose reversal medication - as part of the application process.

Admitting members to the club should be dependent on a screening process, the report details:

“A screening process conducted by an onsite staff member who is a health care provider could help ensure that curious youth and other vulnerable populations (e.g., inexperienced or opioid-naïve) receive balanced and accurate information about the program and the known risks of heroin use, including overdose and addiction.”

If implemented, the approach would be thoroughly evaluated and modified if necessary.

For the approach to be trialled, BCCSU will need to win the support of the national and provincial governments, as well as that of whichever local authorities would oversee the scheme – not only for resources and support, but also to provide a legal pathway. It is currently illegal for such a club to acquire and distribute heroin, but an exemption mechanism exists which would allow a minister to approve it.

The provincial government has said that it is examining the report, and has yet to make a decision on the matter.

Read the full report: Heroin Compassion Clubs