COVID-19 highlights the urgency to expand the “safe supply” opioids machine model

Mar 26 2020, 4:37 pm

Written for Daily Hive by Mo Amir, host and producer of the podcast This is VANCOLOUR, based in Vancouver. 


The world’s first opioid vending machine, the MySafe Project — launched in Vancouver’s Downtown Eastside earlier this year — demonstrates how low-barrier, safe supply programs could provide effective relief to the city’s most vulnerable people, even amid a crisis like the COVID-19 pandemic.

“It’s just one machine,” says Dr. Mark Tyndall, a professor at UBC’s School of Population and Public Health, who leads the MySafe Project. “I’m still at the point where I have to convince people that [MySafe] is a viable thing that works.”

Disquietingly, the COVID-19 pandemic may be making a strong case for the expansion of the MySafe model.

The MySafe Project is an 800-pound machine that resembles a very large ATM. With a large video screen on its front, registered opioid users log into the machine through biometrics that read vein patterns of a user’s palm to authenticate their access to a prescribed dosage of the opioid, hydromorphone.

“It’s regulated. It’s all very tightly recorded.”

The machine is programmed to dispense eight-milligram hydromorphone tablets according to each user’s custom prescription based on a medical assessment. Each dose (two to four hydromorphone tablets) is generally administered one at a time. This requires a user to visit the machine two to four times per day to obtain their prescribed daily amount.

“The one thing to get over is that ‘Well, don’t these drugs kill people and why would you give them these drugs?’-kind of idea. And I have to explain to people that it’s not really the drugs that are killing them. It’s the ‘too potent’ [kind] of these drugs that are killing people,” explains Dr. Tyndall. “If people get a regulated supply of [opioids], they are unlikely to overdose.”

Two months after its launch, MySafe has promising, preliminary results. A few MySafe users soon got jobs, which they had not had in months. All users, according to Dr. Tyndall, saw their street involvement decrease dramatically, including some users who have completely disengaged from any street involvement.

“If you walk out to the Downtown Eastside, most of those people are searching for ways to generate just enough money to get enough drugs for themselves. Just trying to interrupt that hustle is life-changing for people.”

As a result, MySafe’s low-barrier, safe supply strategy removes the incentive for users to commit crime or sex work to pay for drugs. Since the dosages are clean and regulated, eliminating the risk of poisoning or overdose, the users also achieve better health outcomes.

“The police are very supportive of this idea. From their perspective, it’s crime prevention, because why would we want to be chasing people all over the place doing small crimes to get these drugs, when we can just give [the drugs] to them?”

Given the policing and healthcare costs of the Downtown Eastside, access to a safe opioid supply may actually be a more cost-effective method to combat the area’s challenges, while actually undercutting prices of the illicit market’s supply.

“I can give people a whole day’s [opioid] supply for about $6. On the street, they pay $200.”

The worsening COVID-19 crisis has only highlighted the benefits of the MySafe model.

Shipments of illegal opioid drugs into British Columbia stopped due to the border closures included in the federal government’s COVID-19 response. On the Downtown Eastside, the supply of opioids has dwindled to extreme scarcity.

The result is a spike in opioid prices in the street market, which may have several devastating effects: desperate behaviour to procure drugs may lead to increased levels of crime; users may suffer withdrawal that, if not fatal, may require hospitalization; available street drug supplies will be cut with unknown substances, putting users at even more risk for poisoning.

Additionally, it should be noted that over 80% of people found dead due to opioid poisoning were found alone, according to Dr. Tyndall. In wake of the opioid crisis, there was increased advocacy for users not to inject alone so that oxygen masks and Naloxone could be administered, if needed. This peer protection, of course, is not conducive to the types of social distancing measures needed during the COVID-19 crisis.

With MySafe, however, users can discreetly acquire their drugs and use them alone since the regulated dosage is not at risk for contamination.

“The chance of overdosing is virtually zero.”

In effect, Dr. Tyndall’s MySafe Project empowers opioid users with autonomy, privacy, and the security of access to a safe supply of drugs, which would lower both law enforcement and healthcare costs. Perhaps if implemented and expanded years ago, MySafe would have not only prevented many deaths from opioid poisoning but also better protected the Downtown Eastside in the current COVID-19 crisis.

Have a listen to the full This is VANCOLOUR podcast with Dr. Mark Tyndall: