More people now die from overdoses in BC than car accidents. And while Naxolone is a lifesaver in an overdose situation, the current prescription in the face of the overdose crisis is that of treatment – low-barrier, high quality, effective treatment.
Providence’s Crosstown Clinic offers supervised injectable opioid-assisted treatments, mostly with diacetylmorphine (prescription heroin) as well as hydromorphone, another medical-grade opioid. The medication administered at Crosstown is under the supervision of an interdisciplinary team of medical staff/physicians, nurses, social workers and counselors.
“Global visitors come in part because it’s radical, but more because it’s working.”
It is currently the only clinic in North America to offer this type of treatment. However, the recent spotlight on opioid addiction – due to the unprecedented and tragic spike in preventable deaths due to overdose – has put this controversial treatment on the world’s radar.
Crosstown has been in the New York Times, Washington Post, Globe & Mail, and on CBC National. Dr. MacDonald, lead physician at the clinic, was invited to provide testimony before the US Committee on Homeland Security and Governmental Affairs in Washington, DC; Dr. Eugenia Oviedo-Joekes, principal investigator for heroin-assisted therapy research studies at Crosstown, was recently profiled in VICE; medical professionals from across Canada, the US, and South America have physically come to the clinic to see the work being done.
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“Our goal is to get people into care, and to get them to stop using illicit opioid or street opioids,” says Dr. MacDonald. “Many patients will require treatment for the long-term but, over time, some begin to step down to less intensive treatments like methadone, Suboxone, or abstinence-based treatments.”
This is a direction the clinic has already seen their patients move towards, despite Crosstown only having been in operation for a few years. But Dr. MacDonald is quick to credit the patients with being the ones who are achieving the success.
“This is a difficult treatment. It’s supervised, comprehensive care. Patients need to come to the clinic up to three times a day. That takes true commitment,” Dr. MacDonald says. “Opioid addiction is like any other chronic disease in that it’s manageable. Just like with diabetes or hypertension, if people can have access to a treatment that works for them, they’ll take it. They’ll get better. They’re more engaged in care. When this wasn’t available, people were suffering and dying from overdoses and now we see our patients are taking steps towards not only curbing their substance-use disorder, but truly turning a corner.”
The clinic’s patient roster is made up of people, many of whom were grandfathered in from the NAOMI and SALOME studies (both of which were conducted out of Crosstown, and furthered the world’s knowledge of heroin-assisted therapies), who haven’t previously responded to standard courses of treatment. This is said to be approximately 10 per cent of heroin users.
Help for those who need it the most
“We are trying to provide alternative treatments for people who are continuing to inject in the street, and we are not serving them well with the few options we have,” commented Dr. Oviedo-Joekes, following the release of the SALOME findings. “This study, and the pursuit of more treatment options, is a statement to who we are as a community: if a treatment isn’t working, what are we going to do to help the people who need it the most?”
While the study of substance-use disorders is ongoing, we know a few things for certain: that there is no cookie-cutter treatment and that every person with severe opioid-use disorder left untreated is at high risk of serious illness and premature death.
“Our patients are doing well in the midst of the overdose crisis; we haven’t had any patient on our treatment program die from fatal overdose.” says Dr. MacDonald. “We only have something like Crosstown because of Providence fighting for it. And my hope is that someday, this evidence-based, safe, cost-effective treatment will be available for all of the people who need it.”
Crosstown fast facts
- Switzerland has been treating opioid addiction with heroin since 1994; this treatment approach currently exists in eight additional countries in Europe.
- Diacetylmorphine is not intended to replace methadone or Suboxone; rather, it’s intended to complement them as another viable treatment option for those with severe opioid addiction.
- The cost of someone using illicit heroin is at least $45,000 per year, compared to the $27,000 it costs Crosstown to deliver injectable treatment. There’s also a proven correlation between diminished illegal activity.
- As of April 1, hydromorphone compound fees (the prepping of the injection) is now a PharmaCare benefit.
- Renovations to the current Crosstown Clinic at 185 West Hastings Street will allow the clinic to expand, increasing capacity from its current patient roster of 130 to 160, with the goal of getting to 200 patients being treated at Crosstown.