Safer Drug Supply Program causing concern for doctors in Lindsay and area

By Dr. Joan Dafoe, Ross Memorial Hospital, Lindsay

As a community ER physician, I recently provided care to a teenage boy who was brought by ambulance to our rural emergency department. This high school student almost died from an overdose when he ingested pills that he had purchased on the street. After the young man was resuscitated, he told us that he had bought a bottle of 30 tablets of Dilaudid 8 mg, wanting to use these “to get high.”

In the past few years in our emergency department, we have learned from multiple patients that they are buying Dilaudid 8 mg tablets locally. This is an abnormally high dose of this medication. Dilaudid, also known as hydromorphone, is an opioid/narcotic pain medication available by prescription. Patients suffering with cancer pain are often treated with Dilaudid 1 mg every six hours. A patient with a severe injury such as a broken femur might need Dilaudid 2 mg every six hours prior to surgery. In 20 years of practicing medicine in this community, this is the first that I have ever seen Dilaudid 8 mg tablets prescribed to any patient.

A single tablet of Dilaudid 8 mg could cause a person to overdose, leading them to stop breathing and die.

Considering that the family physicians, primary care NPs, surgeons, ER doctors, and palliative care doctors in our community do not ever prescribe Dilaudid 8 mg tablets, the question arises: how are bottles of these pills available to be purchased illegally on the street in our rural community? (Currently the street value of one Dilaudid tablet can be as low as 50 cents.)

It turns out that the likely source of these bottles of Dilaudid 8 mg tablets that are being sold to our teenagers is the “Safer Drug Supply Program” funded by the Canadian federal government. They state online that it is meant to help prevent overdoses, save lives, and connect people who use drugs to health and social services. Patients who have an addiction to fentanyl and are at high risk of overdose are provided with “prescription medication as a safer alternative to the toxic illegal drug supply.” The usual regimen for these patients is daily Kadian (which is a long-acting morphine tablet) along with Dilaudid 8 mg tablets. Patients are dispensed at least six tablets daily from the pharmacy (meaning they leave the pharmacy with a bottle of tablets).  A single patient can be dispensed as many as 40 tablets daily from their pharmacy. Some of these patients are then selling the Dilaudid 8 mg tablets to have money to buy illegal fentanyl.

The reason the patients who are involved in this Safer Opiod Supply Program may be selling their Dilaudid 8 mg tablets is because the prescribed medication is not nearly adequate dosing to replace the amount of narcotic that they are getting from illicit fentanyl. The program may not actually be decreasing the frequency of fentanyl use for many of these patients, in which case it is not lowering their risk of overdose. We are seeing local evidence of high dose narcotics (Dilaudid 8mg tablets) available on the street because of this program.

The Safer Opiod Supply Program is based on a harm reduction initiative without peer-reviewed evidence or guidelines to support the model. The vulnerable members of our communities  who are addicted to fentanyl need and deserve better care. They are marginalized within society and are often marginalized even within the health care system. Harm reduction models are an important part of the solution to the ongoing opioid crisis, along with such things as sublocade (a monthly injection with good evidence that it can reduce narcotic withdrawal symptoms and reduce fentanyl use, thereby reducing risk of overdose and death.) We need to be more open-minded and creative with our harm reduction solutions. We cannot run programs that potentially increase community risk overall.

The current Safer Drug Supply Program is unsafe for the patients involved and is unsafe for the community. There are already Safer Drug Supply Clinics in Oshawa and Peterborough. The New Dawn Medical group has been known to prescribe based on this Safer Drug Supply Program, and they have recently opened a virtual clinic in Lindsay.