This article is part three of a series about results of the drug study initiated by the qathet Community Action Team. Parts one and two were published earlier this year.
Efforts are being made in the community to protect people who use drugs from the toxic drug supply that is killing people.
Kate Hodgson, manager of community health services for Lift Community Services, manages the injectable opiate agonist treatment (iOAT) program, which is designed to provide a regulated supply of opiates for people who use drugs rather than them using street drugs that can be laced with toxic substances such as fentanyl.
Ellery Cleveland, clinical coordinator of iOAT, said the program involves engaging people in a health care setting, specifically through offerings of pharmaceutical alternatives to the toxic drug supply.
“What we have available here in qathet region is opioid agonist therapy, including injectable forms,” said Cleveland. “We have hydromorphone, known as dilaudid. It’s brand name, that folks can access in the form they are most used to using, either in a tablet form or they could inject it.
“One thing we don’t have that is a huge challenge, and this is a problem across the country, is we don’t have good, smokable options for people, and we have a wide range of folks who are used to smoking their substances.”
In terms of eligibility criteria for the injectable program, it must be someone with a history of injection use and opioid use disorder, said Cleveland. It’s a voluntary program and participants are 19 years of age and older.
“Folks can self-refer,” added Cleveland. “Often, we get referrals from health-care providers and sometimes we get referrals from the overdose outreach team and other Vancouver Coastal Health services.”
Relationships develop
She said when the service was co-located with the overdose prevention site, relationships were developed with people who were accessing the site.
“People also come in through the hospital emergency program, through hospital inpatient, and we’re trying to cast a wide net because we know there is a group of people who use substances who are already engaging in health care,” she added.
The iOAT program has been running in qathet since September 2021. The program has a clinic space where people are seen. Some people attend daily, others attend multiple times a day for doses.
“It depends on the individualized care plan for the person,” said Cleveland.
The opioid agonist therapy program has also recently started a fentanyl patch program, offering a fentanyl product for people who are using illicit fentanyl.
“We’re trying to catch up to the potency of the supply that people are using,” added Cleveland.
Hodgson said the goal is to offer options. Right now, hydromorphone and the fentanyl patch are offered, but the program is looking at adding other pharmaceutical options. She said the program here is often behind urban implementation.
Cleveland said an important point is that it is not just the illicit opioid supply that has toxic substances. She said any illicit substances can put people at risk for harm.
“There’s a lot of focus on opioids but there are a lot of other substances that people are using, such as stimulants like cocaine that may also be contaminated with harmful substances,” said Cleveland. “Fentanyl has been a contaminant but it is now more like the baseline norm of opioids on the street. We don’t see as much heroin anymore. “
Cleveland said the iOAT program is limited to the number of people it can support but the goal is to reach 20 to 30 people at a time.
“We do see people transition from our high intensity program to managing their health care and treatment pathways,” said Cleveland. “The goal of the program is to reduce toxic drug-related harm, but also to support people with whatever goals they have. Sometimes those are recovery-oriented goals like engaging in health care and getting stability in other aspects of their lives, reconnecting with family.
“We don’t require people to have a goal of abstinence in order to be in the program but we have had folks where that is a goal. It bridges into the benefits of iOAT, where people have increased stability.”
Hodgson said the program reduces the burden of other emergency health-care services, so people are using the emergency department less.
Interdisciplinary team
Cleveland said iOAT is an interdisciplinary team, so there are nurses, prescribers who are physicians, and there are also non-clinical staff, as well as peer-staff – people with the experience of living with substance use.
“It helps bridge the gap and make the space more welcoming and accessible for many people who may have a hard time walking into an office or clinic situation,” said Cleveland.
The program is funded through Vancouver Coastal Health (VCH) and operationalized by Lift. Hodgson said the program development stages were collaborative. She said there was lots of help from VCH and the local program leaned on the experiences of bigger programs that are already in existence. With Lift, community action team coordinator Kathryn Colby was involved and Cleveland was hired to implement the program. This program is considered the most rural iOAT program. Other programs in BC are in larger centres.
“It took a lot of advocacy on our part as nurses in the community to be able to demonstrate we are able to operate this type of program in a rural setting,” said Hodgson.
Cleveland said those involved in the program are very proud of what they have and are aware of the barriers that exist. She said what she hears most from clients is they don’t want to feel sick.
“They want to find something that meets their needs so they don’t feel withdrawal,” added Cleveland. “People on opioid agonist therapy are at less risk for harm, including death.”
This article is the third in a three-part series about results of the drug study initiated by the qathet Community Action Team.
