B.C. drug experts recommend legal heroin to combat overdose crisis

Could a legal heroin supply help combat the province’s opioid crisis?

It’s an idea being floated in a new report released Thursday by the British Columbia Centre on Substance Use.

The centre suggests that providing legal heroin to users — through the establishment of so-called “heroin compassion clubs” — would help reduce overdose deaths by ensuring the drug supply used is free of fentanyl.

“Over the last two years, almost 3,000 British Columbians have died, and we’ve seen a tremendous growth in organized crime because of the profitability of fentanyl,” said Dr. Evan Wood, executive director of the B.C. Centre on Substance Abuse.

“Recent investigations have concluded that about $5 billion is being laundered every year through the B.C. real estate market, and I can say with a lot of confidence that is just the tip of the iceberg,” Wood added, noting that elected officials have privately acknowledged the fentanyl epidemic is a natural consequence of heroin prohibition.

Medical experts who contributed to the report say one kilogram of fentanyl, which can be obtained rather easily and inexpensively online, can be sold on the streets for some $10 million.

For authors of the report, the hope is that legally regulated heroin sales would have a multi-pronged effect, reducing fentanyl poisoning deaths, preventing opioid addiction by limiting heroin access to users of fentanyl and putting a dent in the illicit proceeds of organized crime.

“It’s clear that one of the challenges of this crisis is that when we identify those at risk, we need to find patient-centred ways to engage with them in an environment that is not stigmatized,” said Dr. Keith Ahamad, medical director of Vancouver Coastal Health’s Regional Addiction Program.

“To be clear, we are not going to let up on creating a comprehensive addiction treatment system. But this model for providing legally regulated heroin to stop overdose deaths now is desperately needed,” Ahamad added.

The report recommends establishing a trial site for the heroin compassion club — also referred to as a buyers club — in a neighbourhood that already sees a high-risk demographic when it comes to fentanyl poisoning, such as Vancouver’s downtown Eastside.

Medical experts behind the recommendation for a heroin compassion club say the idea is modelled after cannabis clubs and buyers clubs established at the height of the AIDS epidemic in the 1980s and 1990s.

The proposed compassion club would be established as a co-operative model and would be run by its members. The report notes that similar and smaller user-driven initiatives exist in an underground capacity but that they too are dangerous, as there’s no way to be certain a drug supply is untainted by fentanyl.

The medical experts behind the report say they recommended that heroin be the legally regulated substance that is supplied because opioid users at high risk of overdosing typically prefer heroin to prescription opioids.