Pharmacists say rural BC needs injectable treatment in overdose crisis fight
VANCOUVER – Chronic opioid users in rural and remote communities in British Columbia need access to supervised injectable treatment that is already available in the Vancouver area, says the head of the BC Pharmacy Association.Geraldine Vance said the overdose epidemic demands immediate involvement by community pharmacists who have the skills to dispense medications, such as the opioid pain reliever hydromorphone, and monitor patients.Vance said Williams Lake and Kelowna are among the communities that need supervised injectable treatment with hydromorphone, which is provided along with pharmaceutical heroin at the Crosstown clinic in Vancouver’s Downtown Eastside.“Not Kelowna, where on a per capita basis the deaths from overdoses are higher. The problem cannot be contained to a few blocks in Vancouver, and everybody knows that.”Two pilot projects involving hydromorphone are underway in Vancouver, with two pharmacies participating.However, Vance said pharmacists could be involved in up to 20 such projects elsewhere in the province.Vance’s association has been in talks with the BC Centre on Substance Use and the BC Centre for Disease Control since last spring about expanding the role of pharmacists during the opioid epidemic.“Our view at this point is that given the nature of how significant the crisis is in the province as a whole, that we should move forward with those pilots,” she said.A report released last week by the BC Centre on Substance Use listing guidelines for health-care providers for use of hydromorphone missed an opportunity to involve pharmacists in pilot projects, Vance said.The report says there’s a need to increase use of hydromorphone, either through stand-alone clinics like Crosstown or existing facilities, such as hospitals or pharmacies, for patients on a stable dose.“Similar to daily pharmacy-witnessed methadone ingestion, prescribed hydromorphone syringes would be prepared, dispensed, self-administered and witnessed by trained pharmacists,” the report says.Vance said pharmacists in the Fraser Valley who were called on to help during a measles outbreak in 2014 gave nearly 1,300 vaccines and could join other health-care providers in stemming the death toll from the illegal and tainted drug supply.The BC Pharmacy Association submitted a report last week to the select standing committee on finance and government services on the 2018 budget, saying its 3,200 community pharmacists are the most underutilized professionals in the health-care system.“We strongly urge the B.C. government to act now and begin maximizing the expertise of community pharmacists to benefit British Columbians.”“Successive provincial government administrations have failed in leveraging the health human resources and infrastructure that is currently available in community pharmacies,” the report says. “As a result, the province has missed opportunities to both better serve the needs of patients and garner savings in the health-care budget.”Mental Health and Addictions Minister Judy Darcy said last week she has tasked health authorities to look into scaling up the use of hydromorphone across the province.Darcy was not available to comment Monday on the role of pharmacists.Implementation of injectable treatment, including pilot projects, would involve health authorities and the ministries of health and addictions, the B.C. Centre on Substance Use said in a statement.“There is a need to pilot and evaluate these emerging pharmacy-based models of care in communities where embedded or stand-alone models do not meet population needs,” it said.The coroner’s service has said 1,013 people died of illicit-drug overdoses in British Columbia between January and August this year, eclipsing a record 982 deaths in 2016.The highest increase in the death rate per 100,000 people occurred in the Okanagan, where the rate jumped from 20.9 in 2016 to 45.6 between January and August.— Follow @CamilleBains1 on Twitter.