Over the past 40 years, Jeff Louden has used many different types of opioids, including heroin and fentanyl, and he’s been arrested time and time again because of it.
“When you’re sick, there's not much you won’t do to get better—sell dope, rob banks, break into houses, whatever,” said Louden, a resident of Vancouver’s Downtown Eastside, ground zero for Canada’s drug-poisoning crisis. According to Crackdown, a drug war podcast of which Louden is a director, he was taken from Curve Lake First Nation when he was a baby and adopted by a white family, under a racist government policy known as the Sixties Scoop that targeted Indigenous communities. He first tried opioids when he was 9.
“I’ve spent most of my life in prison from trying to support the habit and get by,” he told VICE World News.
But things changed in 2019, when Louden, now 55, started receiving prescription fentanyl patches paid for by the British Columbia government to manage his opioid use disorder.
He said the patches, which he has replaced at a clinic three days a week, mean he doesn’t have to commit crimes to pay for drugs. They also prevent him from getting dopesick (experiencing withdrawal)—which can cause crippling anxiety, body aches, chills, and nausea—and help with the pain in his legs.
“In the morning time, I’m not fucking screaming in agony when I try to step out of bed,” said Louden, a former stone mason who has arthritis and said he has no cartilage left in his knees.
Fentanyl patches are most commonly used medically to treat severe pain. But Louden was part of a 2019 pilot program to give the patches to people with opioid use disorder. While the pilot started with just a handful of patients at Vancouver’s Portland Hotel Society, a harm reduction organization, this type of treatment has since expanded, making B.C. one of the only places in North America to prescribe pharmaceutical versions of fentanyl and morphine to people addicted to opioids.
Even though the research is limited, doctors and drug users who spoke to VICE World News said these measures are necessary to help stop overdoses in the era of illicit fentanyl, a drug that’s up to 50 times more potent than heroin and is behind record overdose deaths in Canada and the U.S.
“We've treated heroin use for so long, but it's no longer what's out there,” said Dr. Rupi Brar, an addiction medicine doctor in Vancouver.
Last year, the province announced guidelines around providing a “safer supply” of drugs, noting that its goal is to provide “harm reduction intervention to separate people from the toxic drug supply.” The federal government funds some of these projects.
B.C.’s Ministry of Mental Health and Addictions told VICE World News 3,771 people received opioid medications, including fentanyl products, from March 2020 to February 2021. More than 24,000 have received some type of medication-assisted treatment, though that number is still just a fraction of the more than 100,000 British Columbians with opioid use disorder.
Brar said there’s still a place for more-traditional opioid agonist therapies (treating opioid addiction with long-acting pharmaceutical opioids), including methadone and buprenorphine, but the reality is many drug users’ tolerances have gone up significantly with the rise of fentanyl. Because the potency of street fentanyl is unpredictable, and with it now being cut with benzodiazepines and other drugs, it’s wreaking havoc on people’s bodies and causing many to die.
“We are having an unprecedented number of deaths, and we need to be able to provide alternatives and different options to help people,” Brar said.
Laura Shaver, a Downtown Eastside resident and harm reduction activist, waited a decade for government-funded, prescription heroin. Now that she gets it, she doesn't think it’s strong enough.
About a month ago, Shaver, 43, said she was accepted as a patient at the city’s Providence Crosstown Clinic, the first site in North America to offer people injectable diacetylmorphine (medical-grade injectable heroin) as a means of managing their addiction—and giving them an alternative to illicit fentanyl. Patients visit the clinic up to three times a day to consume the drugs on-site.
But Shaver said after years of using fentanyl, which has largely replaced heroin in Vancouver’s street drug supply, diacetylmorphine isn’t fully managing her withdrawal symptoms, nor is it really getting her high. She’s still supplementing with illicit fentanyl.
“The euphoria I was expecting was not what it is. Not to say I'm not grateful for it,” Shaver said, adding that her reasons for wanting to go to Crosstown are straightforward: “Who wouldn’t want to first off have a safe supply but also a covered supply?”
Now Shaver is hoping her doctor can prescribe her a fentanyl patch as a means of coping with her opioid use disorder. She said she’s already stopped going to Crosstown three times a day.
Dr. Paxton Bach, co–medical director at the B.C. Centre on Substance Use, said retention rates for opioid agonist therapy in the province have been low for the past 20 years, with only one in five people remaining in treatment after a year. There’s a variety of reasons for that, like people often having to physically go to the clinic or pharmacy to get their drugs. Anecdotally, he said, things have likely gotten worse in the fentanyl era because the drugs aren’t always enough to tide people over.
Louden said he knows of many people who drop out of the patch program because it takes time to get up to the right dosage. In his case, it took a few months.
“I am on a lot of fentanyl—enough for a couple of people, they tell me, and god knows how much heroin I’d have to do.”
Even with Louden’s high dose of legal fentanyl, he said he doesn’t feel high and still sometimes supplements with street drugs. Long-term opioid use means many patients will simply be medicating to feel functional.
Bach said the idea of doctors giving people enough drugs to feel high is not widely accepted.
“It is taboo for us to talk about people becoming euphoric off of their opioid agonist therapy or attaining some of that high,” he said. “Some people end up on a high enough dose that it gives them back that feeling, that euphoria, or a warm hug…. And if that’s what somebody needs in order to manage their cravings and help them meet their goals [of] reducing their use or stopping using… then so be it.”
Others don’t want to feel impaired, they just want to feel well, he said, so their dose might be lower.
As for the criticism that the government shouldn’t be paying for people’s drug of choice, Brar said the evidence shows that it’s more cost-effective for the healthcare system to help people who have substance use disorders.
In a CBC op-ed, Dr. Scott MacDonald, lead physician at Crosstown, said it costs about $25,000 a year to provide a patient with diacetylmorphine—compared to about $45,000 annually if that person were to struggle with their addiction and go through the criminal justice system.
Brar said the idea that people who use drugs shouldn’t receive care “reeks of stigma.”
She said the current crisis is a result of bad drug policy that needs to change dramatically.
Drug user activists have previously told VICE World News safe supply needs to be taken out of the medical system and made much more accessible.
“Myself and my colleagues can only do so much with our prescription pad,” Brar said. “What we need is to regulate substances in a way that they’re accessible and they’re safe.”
Follow Manisha Krishnan on Twitter.