A new report is calling for the “urgent” implementation of legally regulated heroin sales and “heroin compassion clubs” in British Columbia as a way to reduce overdoses linked to fentanyl and make a dent in sales of the drug by organized crime.

The BC Centre on Substance Use report released on Thursday builds on the research and advocacy of many healthcare and drug policy experts who have called for a regulated supply of drugs that are only available through the illicit market.

It cites the cannabis compassion clubs and medication buyers clubs that emerged during the HIV/AIDS crisis in the 1980s and 1990s as a potential model for regulated heroin sales and how they could be purchased and consumed.

“[H]eroin could be restricted to members and legally obtained from a pharmaceutical manufacturer, while also undertaking scientific evaluation to assess impacts on reducing fentanyl deaths and the undercutting of organized crime,” the report states.

Members would be allowed to purchase small amounts of pharmaceutical-grade heroin, such as diacetylmorphine, after undergoing screening by a healthcare professional. There would also be compulsory overdose prevention and naloxone training.

The BC Coroners Service reported this month that 1,489 people died in the province died of a suspected illicit drug overdoses in 2018, up slightly from the 1,487 people who died in 2017. The vast majority of those deaths are attributed to bootleg fentanyl.

BC’s provincial health officer declared a public health emergency in April 2016 over the rising rates of opioid deaths.

The most recent data from the Public Health Agency of Canada shows that more than 2,000 overdose deaths that occurred during the first half of the year across the country have been linked to opioids. In 2017, nearly 4,000 people in Canada died of an opioid overdose.

The legal heroin report comes on the heels of another report released Wednesday by the Canadian Association of People Who Use Drugs that also calls for a regulated supply of substances only available through the illicit market.

“For many decades the drug using community has had to risk overdose, poisoning, infection disease transmission,” states the report, which draws comparisons to the regulated alcohol market. “Just as a safe supply of alcohol was not meant to solve all the problems of alcoholism, it did provide the starting point eliminating the need to correct the many problems created from it being illegal.”

The report concludes that while a regulated drug supply will not be a “cure all” or “magic bullet,” it is a “necessary component of ending the war on drugs that has done so much harm to divide and harm our society.”

In 2017, Health Canada made it easier for public health officials to apply for the ability to import prescription-grade heroin in bulk to expand heroin-assisted treatment.

Speaking to reporters last December, Canada’s chief public health officer said that a toxic illicit supply is fuelling the crisis, and that creating a safer supply “is being actively reviewed and discussed” with provincial and territorial governments.

Around 130 people with chronic opioid addictions have had access to pharmaceutical-grade heroin at the Crosstown Clinic in Vancouver since 2014, then the only program of its kind in North America. Many patients experience improved quality of life as they no longer have to turn to the streets, or crime, to obtain their doses.

Earlier this year, another pilot program in Vancouver operated by the Portland Hotel Society began prescribing hydromorphone pills—made from morphine—to 50 patients free of charge. Though the pills are meant to be consumed orally, these patients administer them via injection under staff supervision.