VANCOUVER—A proposal to allow opioid users to buy heroin through a co-operative model could help combat high numbers of fentanyl overdose deaths in B.C. and stem the flow of money into the illegal drug trade.

On Thursday, the B.C. Centre for Substance Use (BCCSU) was joined by public-health experts and people who use drugs to unveil a report outlining a model for “heroin compassion clubs.” Members could legally purchase prescription heroin in a controlled environment.

Dean Wilson, a member of the Vancouver Area Network of Drug Users, said this model has been developed over many years of collaboration with drug users and public-health experts. He said that despite potential stigma against legal drug use, the aim is to keep people alive by providing access to a safe supply.

“We are asking for help and we are going to be designers of our own help,” he said. “Dead people don’t detox.”

Close to 3,000 people died in British Columbia between 2017 and 2018 due to overdoses, according to reports from the B.C. Coroners Service.

Wilson said the buyer’s club model is similar to Insite, the first supervised drug injection site in B.C. and a breakthrough harm-reduction approach. Despite initial pushback, “the world didn’t end” with the opening of Insite, he said, and it became a successful and life-saving model.

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The compassion-club program would operate on the same premises as entry points for treatment services, to which patients would be connected. The drug would be dispensed in personal amounts, under the direction of a public health provider. The program would be restricted to members who have been assessed by a health-care provider as having an opioid addiction. Members would be provided with education around further harm-reduction measures, such as never using alone.

Wilson, 63, an author of the centre’s report, said he sold drugs and spent time in jail for property crimes in order to feed his drug habit. A gram of heroin on the street costs between $140 to $200 and can last a couple of days, he said, versus about $3.80 that users would pay for powdered heroin imported from Switzerland.

Mental Health and Addictions Minister Judy Darcy said she’s had a briefing on the idea but has not yet read the report, adding she plans to “study it very carefully.”

“Our focus has been on safe prescription alternatives to the poisoned drug supply, so this is a very new concept,” Darcy said.

The idea was inspired by buyer’s clubs established during the AIDS crisis, which enabled access to antiretroviral medications and cannabis. It was also based on the success of the SALOME/NAOMI drug trials in Vancouver, which provided patients with prescription forms of heroin.

Dr. Evan Wood, director of the BC Centre for Substance Use, called for “bold leadership” in implementing this model, which he said will combat organized crime and its influence on money laundering.

“It’s staring all of us in the face what a catastrophe that prohibition has been,” Wood said. “The only path forward for better preventing and treating opioid addiction is to wage economic war on organized crime and to regulate and control the heroin market.”

B.C. Attorney General David Eby said in February the emerging connections between B.C.’s illicit drug trade and other problems facing the province — such as corruption, the housing crisis and money laundering — are “deeply troubling.”

Dr. Keith Ahamad, director of the Regional Addiction Program at Vancouver Coastal Health, said that many drug users do not access medical treatment and would be better reached with a non-medical approach.

“Many people are not engaging with the medicalized model well right now,” Ahamad said. “Not everyone who uses opioids lives with addiction, and few people access treatment when their only contact is with a drug dealer.”

The province has faced numerous stumbling blocks in its attempts to halt the overdose crisis.

As of last March, prescription-grade heroin can be prescribed and administered outside of a hospital, such as in substance-use disorder clinics. But Pivot Legal Society pointed out in a 2018 report that significant barriers to access still exist. Doctors must obtain special permission to prescribe the drug to a handful of people, and that permission must be renewed every three months.

The province’s Overdose Emergency Response Centre, created to provide rapid solutions, was criticized in December by some of its own members who said it wasn’t built correctly to achieve its goal.

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The centre’s committee included people who use drugs and people with lived experience. However, Garth Mullins — a member of the B.C. Association for People on Methadone — said institutional representatives firmly opposed increased access to methadone, causing debate to grind to a halt.

Mullins said that with the support of the BCCSU, a prescription heroin program has finally become achievable. BCCSU can use its status as a research facility to lobby Health Canada for an exemption to the Controlled Drugs and Substances Act.

“This model is freedom,” Mullins said. “Applying for (the exemption) is what makes this possible without getting arrested. It’s what makes it possible for us to live, for us to survive. That’s the key to allyship.”

With files from The Canadian Press

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