Dual public health emergencies?

The overdose crisis gets just a fraction of the funding that COVID19 receives from British Columbia's provincial government. 

CASS cofounder Jordan Westfall testifies before British Columbia Select Standing Committee on Finance and Government Services for their BC Budget 2021 consultation. 

June 9th, 2020 

Note full transcript and stream will be available at https://www.leg.bc.ca/parliamentary-business/committees/41stParliament-5thSession-fgs

(transcript)

It’s often said that British Columbia has dual public health emergencies but the provincial funding disparity between the two emergencies is absolutely tragic-  $6 billion for COVID so far, but the Ministry of Mental Health and Addictions budget is only $10 million. The MMHA is responsible for the response to the overdose crisis. The same overdose crisis that killed 117 people last April, while COVID killed 100. 

One example of how poorly funded the overdose response is are the recent recommendations for prescribers in the Dual Risk Mitigation clinical guideline by the BC Centre on Substance Use. 

Recently the Dual Risk Mitigation prescribing guideline recommended providing oral tablet opioid drugs to people with opioid dependence who do not respond well to traditional treatments.  It is assumed these tablets, made to be taken by mouth, will be crushed and injected by patients to replace illicit opioid use. This practice is not evidence based, has never been properly tested for safety and the scientific literature is clear that injecting oral tablets is very dangerous and often leads to extreme adverse health events such as infective endocarditis and excipient lung disease. 

It’s hard to imagine this situation happening to another group of citizens in British Columbia.  What would the reaction of the general public be if we started giving people with diabetes Insulin tablets to inject because they were cheaper?

These are drugs that people need to live, and the province isnt covering them- but they will provide you pills that you can crush and inject instead.

While the cost of the opioid tablet itself might be cheaper to the government, the health costs may not be. This budget mentality neglects to account for potential healthcare complications that come with injecting tablets. 

In other jurisdictions tablet injection is associated with a rise in other health complications afterward.  Tablet particles can get stuck in veins, lungs, and the chambers of the heart after injection. These are devastating complications, and the dual risk guidelines do not mention them to prescribers. 

 To be clear, there are injectable versions of these drugs that are evidence based and approved for maintenance of opioid addiction that should be on the dual risk mitigation guideline.

While an opioid tablet might cost the government 32 cents each, the consequences could mean a rise in heart valve replacement surgeries that can cost sixty thousand dollars each, or lung replacement surgeries at the same cost. This is why the BC Budget Consultation must ensure that every prescriber in BC can provide injectable opioid formulations, and not just tablets to people who need them.

BC needs injectable opioid preparations as available as the opioid tablets dispensed in pharmacies- doctors and their patients should always have this option available. its truly concerning that not a single injectable opioid drug is as available in BC’s pharmacies as the prescribed tablets that are being injected across the province partly as a government cost reduction measure with the Dual Risk recommendations . 

Injectable hydromorphone only has limited pharma coverage in BC, and which means the drug is accessible to only two hundred or so patients in the province’s injectable opioid assisted treatment program. Any provincial expansion is tied strictly to an explicit government order. 

There is no time like the present to change this- We are keeping the safest drugs in BC under the most restrictions which makes no sense in the context of two public health emergencies. We need pharma to produce ampules of hydromorphone and diacetylmorphine that can be dispensed from pharmacies just like tablets are, so people have an evidence-based and injectable option available to them. 

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