A group of people who have real life experience with drug use in British Columbia and Yukon is calling on the B.C. government to support a community-led mechanism for a safe drug supply, in order to combat deaths from poisoning by powerful adulterants like fentanyl and carfentanil.

The BC-Yukon Association of Drug War Survivors is requesting that Minister of Mental Health and Addictions Judy Darcy immediately enact an order that provides a legal framework for drug buyers clubs, starting in particular with diacetylmorphine, or heroin.

The order would fall under B.C.'s Emergency Health Services Act, similar to the ministerial order that allowed for the rapid establishment of overdose prevention sites in December 2016.

The clubs are modelled after the cannabis compassion clubs that emerged in response to the AIDS epidemic of the 1980s and 1990s. They involve club members pooling resources to make bulk purchases from the safest available supply and then using drug-checking services to ensure better quality control in the distribution of heroin.

"You're going to get what you're paying for rather than it being at the whim of the street," said Kevin Donaghy, the president of the association that launched the call ahead of International Overdose Awareness Day on Saturday, Aug. 31.

Conference to examine safe drug supply

Heroin buyer clubs are already starting to take shape in B.C., said Donaghy, who is helping to organize a conference on safe supply that would bring together people who use drugs from across the province in mid-October.

"There's already an economy that exists in every community across the province where people use substances [and] people are purchasing and selling drugs," he said. "It's a process of testing out these models, and we are doing this political work now to try and create a legislative framework that allows us to do this safely."

Until a legislative framework is established, drug buying clubs will operate clandestinely, which Donaghy said fuels the overdose crisis.

People dying of overdoses

"The reason that people are dying is because of the stigma and because of the fear of repercussions of engaging in drug use or illicit activity," he said.

People are most susceptible to an overdose when their tolerance is low, such as when a person is in the early stages of drug use or leaving a treatment program or correctional facility, Donaghy added.

"The people most susceptible to fatal overdoses are recreational users [and] people who are not heavy drug users," he said, noting that people from all socioeconomic backgrounds use illicit drugs.

This is what a client is given when they arrive at the safe injection site at AIDS Vancouver Island in Victoria. (Chad Hipolito/The Canadian Press)

B.C. declared a public health emergency in 2016 following significant increases in opioid-related overdose deaths, and in April Dr. Bonnie Henry, the province's top health official, called for the decriminalization of people caught with illegal drugs.

Decriminalization would help reduce deep-rooted shame and stigmas that discourage people from accessing support services and in turn help to protect them from a toxic supply, Henry said at the time.

Nearly a thousand people in B.C. alone died from illicit drug overdoses in 2016, followed by 1,486 in 2017 and 1,510 in 2018, according to the BC Coroners Service. There were 538 suspected overdose deaths from illicit drugs in the first six months of this year.

Heroin buyer club proposed

"We pause to honour the loved ones who have died in this unrelenting crisis fuelled by a toxic, unpredictable illicit drug supply," Darcy said in a statement marking Overdose Awareness Day on Saturday.

Asked about heroin buyer clubs, Darcy's office did not respond specifically.

"The ministry understands the need to provide a variety of treatment options for people with substance use disorder," a spokesperson said in an email.

"This includes actively looking at expanding legal prescription alternatives to the toxic drug supply that can be provided under medical supervision to save lives."

B.C. is already an international example for tackling the overdose crisis and implementing harm reduction, said Bruce Wallace, an associate professor in the school of social work at the University of Victoria and a scientist with the Canadian Institute for Substance Use Research.

However, he said federal approval for the adoption of prescription drugs to ensure a safe supply would take too long.

Call to change drug laws

"Without that safe supply, it's really been a challenge and we haven't changed the drug laws throughout this crisis," said Wallace, adding that B.C. is the best jurisdiction to push the envelope beyond overdose prevention sites and toward establishing a safe supply.

The December 2016 ministerial order expedited the establishment of overdose prevention sites by skirting federal oversight and ensured staff and people accessing the sites were protected from criminal charges, said Wallace, which is why he's joined the call for a similar order allowing for heroin buyer clubs.

An unidentified heroin user, left, is injected by another man. The opioid crisis has claimed thousands of lives. (Steven Senne/The Associated Press)

"I worked as an advocate for over 10 years in Victoria to try to get supervised consumption services set up —unsuccessfully," he said. "The ministerial order was passed by Terry Lake, and within 24 hours one was sanctioned and opened in the Downtown Eastside [in Vancouver], and within three weeks they were operating in Victoria."

In the year after overdose prevention sites were sanctioned, more than 20 sites were established and garnered around 550,000 visits, with no overdose deaths at any site, according to Wallace.

Drug buyer clubs are the next "extraordinary measure" required to tackle the overdose crisis, he said, noting that a ministerial order would allow for the details to be developed locally in each different community.

Drug users get organized

"I think the drug user unions across the province now are well organized and are basically the first responders to the overdose crisis. They're best situated to be able to move forward with heroin buyer clubs," said Wallace.

The call for heroin buyer clubs is also supported by a report by the B.C. Centre on Substance Use, released in February, which outlines the clubs as a co-operative model to reduce opioid overdose deaths while disrupting the role of organized crime in distributing fentanyl in the province.

To supply the clubs, the centre proposed importing pharmaceutical-grade heroin into Canada from a Health Canada-licensed manufacturer in Switzerland, though it's currently authorized by the federal government exclusively as a "substitution therapy in the case of severe heroin dependence as part of a treatment program with prescription heroin."

In response, the centre called for a discussion about the best regulatory pathway for off-label use of diacetylmorphine at the federal level.

Wherever the safe supply comes from, Donaghy said it's urgently needed and he hopes it's distributed through community-led drug buyer clubs that allow people who use drugs to have autonomy in determining the harm reduction and overdose prevention measures that work for them.

"Even if the [provincial] response is a 'No,' at the very least we're forcing them into a position to have to say that," he said. "That in and of itself pushes the issue further."