Increasing the scope of Harm Reduction: Providing low barrier Injectable Opioid Agonist Therapy inside an overdose response room.

Lindsay Mackay, Christy Sutherland

Issue -The introduction of fentanyl to the street drug supply in BC resulted in a public health crisis— almost 7,000 people have died of opioid poisoning since the onset of the epidemic in 2016.

Setting - Vancouver, BC, an epicentre for homelessness in Canada. British Columbia had 1,449 overdose deaths in 2017.
Project – Hydromorphone, an opioid that’s demonstrated to be non-inferior to heroin for injectable opioid agonist treatment, is readily available as a prescription in Canada. We established a low-barrier iOAT in an existing supervised consumption room.

The iOAT serves as an opiate substitution for people with severe opioid use disorder. Patients attend twice a day for a supervised injection, in an integrated supervised-injection site, where each patient gets a prescribed dose of hydromorphone that they inject under supervision. The treatment is combined with an oral therapy such as methadone and strong connection to primary care.
A key success of the program is employing people who use drugs. We pay a living wage to ensure that the program reaches the most marginalized group of drug users in our community, making them comfortable and welcomed.

Outcome -Since the program’s inception in 2016, we have treated 280 people. We currently have 80 enlisted,. People enrolled in iOAT connect with primary care and decrease criminal behaviour. Overall, patients stabilize, use less drugs, decrease crime, exit sex work, and gain housing and employment. They move along the continuum of care to match their needs. iOAT serves to deter drug users from a poisoned street drug supply, which often causes unintentional death from overdose.