Opioid Vending Machines Proposed In Vancouver

By Paul Gaita 01/05/18

The proposed vending machine program would make hydromorphone available to registered users.

hand pushing button on vending machine operation panel keyboard

With the death toll from fentanyl-related opioid overdoses confirmed at nearly 1,000 for 2017, health officials in Vancouver, Canada, have proposed a pilot program in which an opioid painkiller could be obtained through a system of vending machines.

The proposed program, which could be ready for launch in March 2018, would distribute the pain medication hydromorphone—which is often marketed under the brand names Dilaudid or Exalgo—to registered users several times per day, according to Dr. Mark Tyndall, executive medical director for the British Columbia (B.C.) Centre for Disease Control.

The vending machine program would be the latest effort by the B.C. government to combat opioid overdoses since declaring a state of public health emergency in 2016.

Injectable hydromorphone, as well as diacetylmorphine (medical-grade heroin) is currently available to individuals with chronic substance dependency issues at Vancouver's Crosstown Clinic and the first federally authorized supervised injection facility (SIF) in North America, Insite, opened here in 2003.

But according to Tyndall, the programs may not reach enough people in B.C. in a manner that can adequately address the rising opioid overdose numbers.

"We don't have really anything to offer people who are dying around the province in smaller communities, where sometimes they don't even have a doctor who can prescribe methadone and certainly will never have a supervised injection site," said Tyndall.

Tyndall's proposed vending machine program would emulate a similar system in Ontario, in which patients can receive prescription drugs through dispensing machines with the consultation of an off-site pharmacist, with whom they communicate through a two-way video monitor.

The opioid vending system would be a regulated system where users, after being assessed with an existing dependency on opioids, would be registered and then issued a card that would allow them access to two to three hydromorphone pills, several times per day. 

That number is based on research conducted by the B.C. Centre for Disease Control, in which participants reported that two pills (or approximately eight milligrams) three times a day, would be an adequate amount. However, Tyndall suggested that certain qualifying individuals could be eligible for a two- or three-day supply in the same manner as take-home methadone.

Security is a major concern for the proposed machines, according to Tyndall, who notes, "we don't want people kicking these things in and stealing all the pills, and we don't want situations where people are taking out big quantities and selling them on the street." The cost of the program is also under consideration; health authorities have yet to decide how much participants would pay, if at all.

Funding for the vending machine program would come from a three-year, $1 million grant from Health Canada, which would first be spent on expanding access to hydromorphone through supervised injection sites and supportive housing units that would also dispense methadone and Suboxone. The remainder of that fund would go to the vending machine program.

Tyndall said the proposed program at first "sounded a bit off the wall, and now it's pretty well accepted." Other health officials in Canada have weighed in on the notion, including Allan Malek, chief pharmacy officer of the Ontario Pharmacists Association.  

In an interview with CTV News, Malek said that while the program will require monitoring, such ideas are a necessity in the face of the opioid epidemic.

"In terms of what's happening in B.C. and other parts of the country, these are discussions that have to be had," he said. "People are dying. Something has to be done."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, Amazon.com and The Los Angeles Beat, among many other publications and websites.