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Expansion sought for Vancouver drug-dispensing machine idea

Opioid vending machine

Don Durban holds his palm up to a screen on a tall steel box akin to a vending machine crossed with an ATM that displays his first name and an identification number seconds before dispensing what he calls a life-saving plastic package.

Durban, 66, takes out two small hydromorphone pills and leaves a storefront with the heroin substitute he gets there four times a day as part of a program aimed at tackling an overdose crisis that has killed an estimated 5,000 people in British Columbia since 2016.

"I don't have to smoke fentanyl. It's saving lives, and I'm here to save mine," Durban said.

The machine, called MySafe, is bolted to the floor in a building next to an overdose prevention site in Vancouver's Downtown Eastside.

Dr. Mark Tyndall came up with the idea for the machine. He stocks it with hydromorphone delivered by a pharmacy for drug users whose urine has been tested for the presence of fentanyl.

Tyndall, who has spent 20 years working in harm reduction and is a professor of medicine at the University of British Columbia's school of population and public health, said a biometric scanner in the machine identifies patients who are dispensed particular dosages of the pain-management opioid sold under the brand name Dilaudid.

Eight patients are using MySafe and three more were added this week. The machine can be programmed to provide the drug for 48 people, Tyndall said, adding most of his patients have been swallowing the hydromorphone, which is sometimes crushed and cooked before being injected intravenously like heroin.

His vision would see MySafe machines installed in overdose-ravaged communities across Canada, but in Vancouver, the epicentre of the opioid crisis, only one other doctor has come on board to prescribe hydromorphone from the machine.

Resistance from physicians so far is possibly because other "medicalized" models — where patients use methadone or inject a medical grade of heroin under supervision — have become the norm, even though his program is cheaper to run and does not require supervision, Tyndall said.

"This is a harm reduction thing where I don't want to see people continue to buy fentanyl and die."

Concerns about diversion of hydromorphone dispensed from MySafe are negligible because patients in the program are monitored and anyone they may be passing the drug on to could be saved from the illegal drug supply known to contain fentanyl, Tyndall said.

"This is the same arguments against harm reduction altogether, that we're just enabling people and what is the motivation to them to stop using drugs if we're just giving them drugs? What I've seen people go through to get illegal drugs, it's crazy."

Tyndall said patients who use MySafe can use drugs alone, the way most people do, without fearing their addiction could kill them.

Health Canada said in a statement it is aware of the project, noting the dispensing of medication falls under provincial regulations.

British Columbia's Ministry of Mental Health and Addictions said it will await the results of the independent project involving MySafe.



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