Virtual clinics prescribe safer-supply drugs to people as opioid crisis deepens

Three relatively new virtual health-care clinics in London are prescribing opioids to people who would otherwise buy toxic drugs on the street.

Two of the clinics are larger operations that function specifically to treat substance use, while a third is run by a doctor from Hamilton who specializes in treating marginalized patients. 

"We are the first line of contact for patients who have been using the contaminated street supply and we have seen the difference in them when they are prescribed safer supply," said Nasir Ladak, who manages Chapman's Pharmacy in Old East Village.

Prescribing hydromorphone, known by its brand name Dilaudid, as an alternative to the toxic, unregulated drug supply is commonly known as safer supply. 

True North Medical, a virtual care "addiction medicine program" based in Toronto, has a small office within Chapman's, Ladak said. True North provides Chapman's with urine sample testing kits, which can show within minutes if a person has the prescribed medication or something else in their urine. The aim is to prevent a patient from taking their prescription and selling it for street drugs, known as diversion. 

"The urine test can detect morphine or fentanyl so we know if patients might be using from the street supply," Ladak said. "The prescriber can see it at their end and they discuss their findings with the patients." 

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Stephen was an active, curious toddler and a smart, shy child. He was also an adult who struggled with addiction. His parents say he knew the risks of street drugs but his addiction was too strong.

Patients are tested any time there's a new prescription, to make sure they're still taking the prescribed medicine, Ladak said. Those who have been prescribed the alternative opioids have seen their lives improve, he added.

"Their secondary conditions, their overall health, their mental-health issues — we definitely see positive health outcomes," Ladak said. "A person completely out on the street has so many health issues and when they start using the safer supply, the prescribers can target the secondary issues." 

Seeing patients get jobs and housing and rebuild their lives is rewarding, he added. 

In London, the safer supply spotlight has focused on Dr. Andrea Sereda's clinic at the London Intercommunity Health Centre. The clinic has funding from Health Canada to provide wrap-around care such as case managers, nurses and social workers for patients getting alternative opioids. Most live on the street and with complex health conditions. 

"We prescribe to patients who are very high risk. We can only see about 300 people for our intensive safer-supply program, but we know there are at least 6,000 people in London who use fentanyl," Sereda said. "We know that 80 per cent of people who die of fentanyl overdoses are housed members of the community who have jobs they go to every day, people you might see at the bank or the grocery store. Virtual health care models could be quite appropriate for them."  

Patients' lives improve, pharmacist says

New Dawn Medical is another virtual clinic, which operates at the Medpoint Care Pharmacy and Walk-in Clinic downtown. A doctor sees patients virtually and an on-site clinical assistant liaises with a pharmacist about the prescription the patient requires. 

"We want to offer many services to our patients," said Nauman Shaikh, a pharmacist who is the manager and owner of the MedPoint facility. 

"We don't focus on one issue. We also talk to patients about their blood pressure, their cholesterol," he said. Whether getting methadone or Dilaudid or medication for a headache, people feel better when their symptoms go away and their ailments get better, he added. 

 "When you treat something that is bothering a patient, when they get the right medication, their attitude is going to change. They're going to be more uplifted," Shaikh said, adding that staff at the pharmacy work with the prescribing doctors from New Dawn Medical to prevent patients from misusing medication. 

"We do keep an eye out and if we get diversion reports or missed doses, we always ensure the doctor is in the loop. We talk to the doctor and the patient so everyone knows what's going on." 

Dr. Dennis Divalentino, who sees patients virtually on the second floor of Clinic 528 on Dundas Street, did not return calls from CBC News. His clinic is on a different floor than the clinic, where Dr. Martyn Judson prescribes methadone and suboxone to help people who have used opioids to reduce their withdrawal symptoms and curb cravings. 

Judson said he doesn't support the safer supply clinics.

"Suboxone and methadone stop patients from feeling euphoric and prevents people from getting high from using other opioids," he said. This supposed safer supply, Dilaudid, is short-acting, rapidly absorbed, causes euphoria and a patient goes into withdrawal five or six hours after taking the drug." 

Prescribing alternative opioids is overused, Judson said, and can be detrimental for his patients, who come to the clinic for methadone or suboxone. 

CBC News reached out to New Dawn Medical and True North Medical but did not get a response by time of publication.