More hydromorphone in Sarnia concerning: local doc

An addictions doctor in Sarnia says he’s concerned that a surge in hydromorphone may be fueling more area opioid drug dependency.

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Del Donald, who sees withdrawal management patients at Bluewater Health and heads Bluewater Methadone Clinic, said he first started seeing patients about seven months ago in withdrawal management who’ve been receiving hydromorphone pills — specifically, Dilaudid 8mg — through safer drug supply programs.

Only one out of the 15 people to whom Donald spoke, he said, told him they actually used their safer supply pills.

“All the rest sold them,” he said.

Diverting that medication could lead to more opioid addiction in the area, Donald said, comparing it to the fallout of OxyContin overprescribing more than 20 years ago that helped fuel the opioid drug crisis.

Ontario had more than 2,600 opioid-related drug deaths last year, including 36 in Sarnia-Lambton, preliminary figures indicate.

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A toxic drug supply, including variations of fentanyl and carfentanil, often with unknown substances cut into them, has been linked to the crisis.

People with higher opioid tolerances have said “the Dilaudid 8s do nothing for me’” Donald said, noting he’s heard his patients still get them because the pills are worth money.

If you have little money, “and all of a sudden somebody is give you 30 or 40 D8s every day. . . and they’re worth $5 each (on the street), now you have $200 a day tax-free. Are you going to try and get clean now?’” Donald asked.

“No, because you can buy all the fentanyl you want.”

The amount of hydromorphone police seized in Sarnia rose by more than 170 per cent from January to August 2024, compared to all of 2023, Sarnia police spokesperson Marika Sylvain Groendyk wrote by email.

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Police seized 187 tablets in 2023, but more than 500 as of early September this year, she indicated.

Donald, who said he believes hydromorphone in the past made its way to Sarnia from places such as London, said he’s aware of three pharmacies in Sarnia now dispensing safer supply through telemedicine providers.

Vishal Patel, a pharmacist at Exmouth Pharmacy, said his is one, and has been since before he helped buy the pharmacy about a year ago.

There have been up to three patients using the program through the pharmacy, which partners with doctors from New Dawn Medical, who prescribe and check on patients remotely, he said.

Patel said he’s trying to phase out the program, referring patients elsewhere, because he’s also concerned about drug diversion.

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“I don’t have any proof, but I have heard from so many other people the issue of drug diversion,” he said. “And being a health care professional, I don’t want to encourage that, at least (not) in my pharmacy.”

New Dawn medical director, Dr. David D’Souza, said safer supply started with the emergence of stronger street drugs including carfentanil in recent years.

Methadone and Suboxone opioid replacement programs, which help keep opioid withdrawal symptoms at bay but still allow people dependent on the drugs to function, weren’t sufficient, he said.

They “stopped working for a lot of these patients who are using very, very strong street drugs,” he said.

The federal safer supply harm reduction program was created to help save lives by giving people alternatives to toxic street drugs to fill that void, he said.

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“We know that, of course, there are some issues with selling,” he said about safer supply, noting people also sell methadone and Suboxone.

“With safe supply, it’s obviously potentially more of an issue,” he said.

Safeguards include confirming program participants are daily fentanyl or heroin users, and confirming they’ve used methadone for “a good amount of time” and with higher-end doses but haven’t been able to quit or significantly reduce their street drug consumption, he said.

Hydromorphone is provided to manage withdrawal symptoms between appointments, he said, as “people go into withdrawals overnight, even before they see the doc the next day.”

New Dawn patients are seen every day, urine samples are monitored and restrictions are put in place if people are found to be selling medication, he said.

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That includes not allowing people to take home doses, or removing people from the program, he said.

“Ours is very secure, as secure as you can get,” he said about the program, noting New Dawn is only in communities where there have been high levels of potent street drugs, including Sarnia.

“We’re here to respond to a need in society,” he said. “Some patients are very, very sick and we’re trying to help those patients … but we’re also trying to balance that as much as possible with the safety of our community.”

An official with Vidal Pharmacy, the other address in Sarnia listed as a New Dawn locationdeclined an interview about safer supply.

About 30 patients receive safer supply through New Dawn in Sarnia, D’Souza said.

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“There’s not a lot,” he said.

Yasser Handawi, a pharmacist at Wellness Pharmacy in Sarnia, said about eight or nine patients get safer supply from his pharmacy and a telemedicine program with trueNorth Medical Centres.

Officials with trueNorth didn’t respond to a voicemail requesting comment.

Handawi said he’s heard from patients the program is helping.

“They are decreasing the amount of fentanyl and decreasing the withdrawal side effects when they are off fentanyl for a longer time,” he said.

He wasn’t aware of diversion concerns, he said, nor that police in Sarnia have seen more hydromorphone seizures.

He’s on board with measures to ensure patients are taking their prescribed medication, to limit diversion, he said.

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More psychological supports and space for substance-dependent people looking to quit, like a 24-bed addictions hub in the works at Bluewater Health, also needs to be available, he said.

A spokesperson for the College of Physicians and Surgeons of Ontario, the regulator for doctors in the province, noted there are guidelines for physicians considering prescribing opioids virtually.

The college “also has expectations for physicians who prescribe drugs, including narcotics and controlled substances, and has specific guidance for physicians who prescribe safer supply opioids,” Laura Zilke said.

Doctors who have concerns should speak with the college, said Shaun Bisson, a spokesperson for Lambton Public Health.

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There have been more than 30 opioid-related deaths in Lambton every year since 2020, when there were a record 43.

Preliminary public health data shows 18 so far in 2024.

Lambton’s opioid-related death rate per 100.00 people was above the provincial average in 2023, according to Public Health Ontario.

The issue of safer supply also has been politically charged, with Conservative Party leader Pierre Poilievre calling harm reduction and safer supply programs examples of Liberal and NDP “wacko” politics, and claiming entertained pills are flooding Canada’s streets and schoolyards.

Gillian Kolla, a public health researcher at Memorial University in Newfoundland, recently told The London Free Press that people commonly share safer supply hydromorphone with others in heavy withdrawal “because everyone knows how awful withdrawal is.”

– With files by The London Free Press

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