Help fentanyl labs make a safer drug

Illegal fentanyl lab operators don’t intend to kill users. They would prefer to have return customers. The problem, I suspect, is that the fentanyl used is so concentrated that it’s hard to dissolve to a uniform consistency. The resulting doses are uneven –from low to deadly. It’s a good idea to provide testing facilities for fentanyl cooks to let them know the potency of their product. Dr. Tyndall of the BC Centre for Disease Control says:

  fentanyl lab. image: Global news

“I’m still firmly of the belief that nobody’s actually trying to kill people. These manufacturers don’t know what they’re doing and they’re putting out ridiculous concentrations of these drugs.”

The BCCDC recommends an expansion of drug-checking services where anyone, including producers of illegal fentanyl, can have their drugs tested for toxicity. B.C.’s Minister of Health, Judy Darcy, endorses the expansion.

As it stands, drug policy is perverse because we tell users not to use street drugs but provide no other option when legal supplies fail.

“We strongly advise people to stop using street drugs,” says Dr. Tyndall, “and if they can’t do that, then we offer them … Suboxone or methadone, and if that doesn’t work, we basically tell them to go and find their own drugs even though there is a very real possibility of dying.”

The BCCDC suggests ten “areas of action.” If they were adopted, opioids would be essentially legalized much in the way that marijuana will be next year. Grower’s clubs and individuals would be allowed to make medical grade opiates. To clarify, opiates are derived from poppies whereas opioids include all synthetic and natural products.

Legal opioids are not likely to happen any time soon. I started lobbying for legalization of cannabis 40 years ago and look how long that took. Optimistically, with the model of legalized marijuana to be established soon, it won’t take another 40 years for the legalization of opioids.

Even without legalization, off-label uses of opioids are allowed. The BCCDC suggest dispensing take-home opioids such as oral hydromorphone which users could take home, grind up, and inject without supervision.

If the above recommendations only seem radical, it’s only because of a false sense of what criminalization can achieve. Criminal law can’t accomplish societal goals. If we want to stop people from using harmful drugs, criminalization has been a dismal failure. Instead, make drugs legal and educate people of the unhealthy consequences of use. It works with tobacco. If the goal is harm reduction, the recommendations don’t seem so radical.

Imagine that we are talking about baby strollers instead of drugs, and that some early models collapsed resulting in injury or death. An irrational solution would be to make strollers illegal. The sensible solution would be to regulate manufacture of the strollers to make them safe.

Prohibition of opioids isn’t working. It didn’t work for coffee, cigarettes or alcohol.

If the current trend continues, the death rate will continue to climb. More than 1,500 will die in British Columbia this year -ordinary people like friends, family and neighbours. Forget the stereotype of street people overdosing in alleys: 90 per cent of deaths are indoors. Isn’t it time to abandon prohibition and give harm-reduction a chance?

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Double-dipping and wait times

Doctors are to blame for double-dipping but not for the long wait times in B.C.

image: Global news

Rosalia Guthrie of Salmon Arm found out the hard way about double-dipping. After waiting for 16 months, her surgeon’s secretary gave her the number of another clinic. To her surprise, she discovered that the other clinic was run by the same surgeon –and that she would have to pay.

Guthrie paid $500 to get in the door of the private clinic and another $3,850 for a written report. She didn’t have to pay for the actual surgery. That was covered by health care and only one-tenth of what she paid. The surgeon was paid $410.67 for the surgery done in a public hospital at UBC.

The surgeon did a number of things wrong. Double-dipping is illegal. That’s where doctors bill both the patient and the province for different aspects of the same treatment. And doctors are forbidden from charging patients for reports while advising patients on publicly-insured treatment. Also, the B.C. College of Physicians and Surgeons dictates that before referring patients to clinics, doctors must disclose if they have a financial interest. The surgeon did have a share in the clinic where Guthrie was treated and that wasn’t disclosed.

Doctors are not to blame for long wait times. That blame for that lies squarely at the feet of the government of British Columbia. The BC Liberals have failed to provide access to operating rooms for surgeons says Judy Darcy, the NDP spokesperson for health:

“There are operating rooms that sit idle, MRIs that sit idle for many hours of the day. We need to invest in innovation to use our capacity to the maximum.”

If hospitals can’t provide operating room times for doctors, the province should build public clinics I argued earlier. There is no shortage of doctors; there is a shortage of operating rooms for them to work. In a survey done by the Royal College of Physicians and Surgeons, 208 fully trained specialists -16 per cent of those surveyed- were under-employed because “. . .there aren’t enough ORs.”

Some doctors contend that, while they may be doing something illegal, they are relieving patient suffering. Patients may lose their jobs while waiting or they may become addicted to pain-killing opioids.

Private clinics are expensive. Doctors can’t run them without charging patients. Dr. Ross Outerbridge, The founder of the Kamloops Surgical Centre, explains: “We factored in all the cost and a reasonable profit margin and that is what we charge the private patients.” But the whole realm of private clinics is unregulated. “I know that at other clinics, they overcharge,” says Dr. Outerbridge. ” I don’t personally agree with that – but it is very difficult, because nothing is being done about it.”

The BC Liberals have balanced the provincial budget by underfunding health care. British Columbia has the largest number of private clinics in Canada. While we are paying fewer taxes, we are likely paying more for health care when the cost of private clinics is factored in.

Yes, taxes would be higher but public clinics would be better than the illegal, unregulated, Wild West of bootleg medicine sold on the side of public medical practice.