Why aren’t doctors prescribing Dilaudid in BC? A lengthy #thread
Over two thousand people in BC have prescriptions for safer tablet opioids, benzos, and stimulants through BCCSU’s Dual-risk Mitigation guideline. (1/24)
Over two thousand people in BC have prescriptions for safer tablet opioids, benzos, and stimulants through BCCSU’s Dual-risk Mitigation guideline. (1/24)
This guideline provides advice to prescribers on which drugs and dosages are recommended for patients that are at “dual risk” of overdose or contracting COVID-19.
The goal is to support physical distancing among PWUD, (2/24)
The goal is to support physical distancing among PWUD, (2/24)
by providing prescriptions so people don’t have to hustle, or go see a dealer several times per day for #streetsupply which means less risk of COVID contraction/overdose. (3/24)
This is from a report on the Dilly 8 pilot project that highlights the health and safety concerns from both BC’s Colleges of Physicians and Pharmacists prior to the release of the dual-risk guidelines. (4/24)
“The use of an oral medication for injection could potentially cause harm, including blockages in the vascular system.”
The Colleges weren’t buying that tablet injection was safe. (5/24)
The Colleges weren’t buying that tablet injection was safe. (5/24)
They also seem puzzled because there is an injectable version of hydromorph readily available in BC:
“The use of prescription pills for injection, when a liquid injectable is readily available, was considered to be troubling”
No doubt. (6/24)
“The use of prescription pills for injection, when a liquid injectable is readily available, was considered to be troubling”
No doubt. (6/24)
With BC’s Colleges of Physicians and Pharmacists not buying it, the report says “barriers include policies, practices, and attitudes require collaboration with external stakeholders such as regulatory bodies, health professionals, (7/24)
or health organizations to overcome”
The project decided that getting ethics approval was necessary “it became clear… that structuring the pilot as a research study would help to create buy in from the College of Physicians and Surgeons of BC, (8/24)
The project decided that getting ethics approval was necessary “it became clear… that structuring the pilot as a research study would help to create buy in from the College of Physicians and Surgeons of BC, (8/24)
and the College of Pharmacists of BC, and therefore from the clinicians needed to prescribe for the pilot.”
The ethics review was supposed to put prescribers at ease. In March 2019 the pilot project was submitted for ethics approval.
Buy in is needed. (9/24)
The ethics review was supposed to put prescribers at ease. In March 2019 the pilot project was submitted for ethics approval.
Buy in is needed. (9/24)
This hasn’t changed. Even Health Canada recently stated that more buy in from provincial governments and regulatory agencies was needed. In the mean time Health Canada helps out with funding for pilot projects. (10/24)
Between the time that pilot project was submitted to ethics and the release of
BCCSU’s Dual-risk guidelines, it isn't clear what happened regarding ethics. (11/24)
BCCSU’s Dual-risk guidelines, it isn't clear what happened regarding ethics. (11/24)
Bccsu"s dual risk guidelines were published in March 2020 without any information for prescribers about these health risks.
Some doctors have prescribed, like stated over 2000 people in BC have tablet prescriptions. (12/24)
Some doctors have prescribed, like stated over 2000 people in BC have tablet prescriptions. (12/24)
But considering how many British Columbians struggle with opioid dependence, approximately 83, 000 people according to research published recently.
This doesn’t even include the many people at risk who use illicit stimulants (13/24)
This doesn’t even include the many people at risk who use illicit stimulants (13/24)
Prescriptions for a few thousand people is sadly “a drop in the bucket” compared to what is needed.
As COVID physical distancing measures took their toll on many, overdose deaths across Canada skyrocketed. Meanwhile in Vancouver, the street price of Dilaudid plummets. (14/24)
As COVID physical distancing measures took their toll on many, overdose deaths across Canada skyrocketed. Meanwhile in Vancouver, the street price of Dilaudid plummets. (14/24)
After five plus years of illicit fentanyl Dilaudid doesn't cut it for a lot of people.
Obviously BC needs safe drugs like no tomorrow, 2020 was a record breaking year for overdose deaths. Nobody wants to prescribe them. (15/24)
Obviously BC needs safe drugs like no tomorrow, 2020 was a record breaking year for overdose deaths. Nobody wants to prescribe them. (15/24)
It’s hard to inform patients about health risks when the guideline you’re told to consult (BCCSU’s Dual-risk) has none of that info.
Proposed solution: expand prescribing privileges to nurses.
Cool. (16/24)
Proposed solution: expand prescribing privileges to nurses.
Cool. (16/24)
But keep in mind that the issue was never that there weren’t enough doctors. There is. Most of them are hesitant considering the lack of support from their Colleges. That lack of College support, (17/24)
at least partly comes directly from the known health risks of tablet injection.
"As independent regulators, the Colleges cannot be forced to take action: a strong relationship is required. (18/24)
"As independent regulators, the Colleges cannot be forced to take action: a strong relationship is required. (18/24)
" That means building a relationship with the Colleges is absolutely VITAL for a successful safe supply program.
Expanding prescribing to include nurses is a bold, courageous step forward but it does not address the underlying issue at all. (19/24)
Expanding prescribing to include nurses is a bold, courageous step forward but it does not address the underlying issue at all. (19/24)
It also looks it's going to take awhile for nurses to get training.
Time for a second opinion British Columbia?
As we wait for promised expansions in safe supply access people die by the hundreds each month.
Time for a second opinion British Columbia?
As we wait for promised expansions in safe supply access people die by the hundreds each month.
We have every reason to have hope in BC even with the crisis that never ends.
BC has everything it needs to make safe supply happen but fresh perspectives are required.
BC is home to the research base, to a nonprofit pharma company dedicated to producing safe drugs, (21/24)
BC has everything it needs to make safe supply happen but fresh perspectives are required.
BC is home to the research base, to a nonprofit pharma company dedicated to producing safe drugs, (21/24)
not to mention the introduction of injectable hydromorph the last safe pharmaceutical opioid approved in this country.
BC's government should start consulting with a diversity of voices on #safesupply. (22/24)
BC's government should start consulting with a diversity of voices on #safesupply. (22/24)
British Columbia can set a precedent for the entire world with safe supply but we need the buy in, the evidence, the pharmaceutical supply, and the stakeholders to make this a reality. (23/24)
It will change absolutely everything.
@vancolour @ctv_jon @CTVVancouver @IRPP @BCGovNews @ryanjespersen @theprovince @VancouverSun @CBCVancouver @VIAwesome
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