Vending machines Used to fight opioid crisis

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This article was published 27/01/2018 (2824 days ago), so information in it may no longer be current.

Among their many differences, Canada and the United States share a common crisis: opioid overdoses.

Drug overdoses are the leading cause of accidental death in the United States, killing more people than the AIDS epidemic at its peak. More than 42,000 Americans died of opioid-related causes in 2016, and the crisis shows no signs of receding.

Canada, too, is in the grip of an opioid overdose epidemic, but public health officials in British Columbia — which is projected to account for nearly one-third of overdose deaths in the country in 2017 — are hoping to prevent a surge in deaths with a novel approach: a vending machine that distributes prescription opioids to addicts.

The BC Centre for Disease Control (BCCDC) announced last month that it plans to install three vending machines this spring that will dispense hydromorphone pills, a powerful prescription opioid, to people with a high risk of overdose. A landmark study in 2016 found the painkiller to be an effective opioid replacement therapy, and experts say it could also reduce dependencies on contaminated street drugs cut with lethal substances such as fentanyl.

A $1-million grant from Health Canada will help fund the project, which officials say could be expanded as early as this summer.

“This is an emergency crisis situation,” said Mark Tyndall, the executive medical director of the BCCDC and a backer of the project. “We don’t have the luxury of pilot-testing these things on a few people over the next year.”

At least 1,460 people died of an opioid-related overdose in Canada in the first half of 2017, a figure that Canada’s public health agency projects will surpass 4,000 once data is reported for the rest of the year. B.C. declared a public health emergency in 2016. More than 1,208 people died of opioid overdoses from January to October 2017, according to the B.C. Coroners Service.

Fentanyl, a synthetic opioid that is up to 100 times more powerful than morphine, was detected in 83 per cent of overdose deaths in B.C. It is increasingly being used to cut street drugs such as cocaine and heroin — sometimes surreptitiously — dramatically boosting their potency, with often-deadly consequences.

Death rates from drug overdoses in B.C. are almost as high as those in the American states hardest hit by the opioid epidemic. In B.C., the drug overdose death rate was 30.2 deaths per 100,000 people from January to October 2017. In Delaware and Rhode Island, it was 30.8 per 100,000 people in 2016.

The severity of the crisis in B.C. has pushed it to go further than the rest of the country in finding ways to reduce the harm done by drugs. The province is home to eight supervised injection sites, where addicts ingest illegal drugs under the supervision of nurses who can intervene in case of an overdose. Since 2011, Vancouver’s Crosstown Clinic has offered injections of pharmaceutical-grade heroin to addicts, and it recently began administering injectable hydromorphone for opioid addicts. But while these programs have been effective, officials say that their models are costly, difficult to scale and limited in their accessibility.

The vending machine project could solve those problems. Under the pilot project, drug users would be able to get two to three hydromorphone pills three times a day. Each tablet costs roughly $3 per day — far less than the $25,000 per person per year that it costs for the programs at the Crosstown Clinic. The machines are relatively inexpensive, making it easy to expand the program quickly.

Vancouver police Sgt. Jason Robillard said that while there is a need for projects like this one, he has concerns about “the safety and security of the people using the machines, and keeping the pills inside the machines secure.”

Tyndall said those concerns are unfounded. A company with experience designing vending machines for cannabis — which also requires extra security — has created prototypes of opioid-dispensing machines. The units would be linked in real time to monitors and accessed using biometrics. The small quantity of pills dispensed and severity of the users’ addiction make it unlikely that they would sell their pills, he said. And if they did, the pills would be safer than toxic street drugs.

— Washington Post