Canadian doctors could soon be allowed to offer patients prescription heroin as a method of treatment for a severe addiction to opioids.
Today (May 13), Health Canada proposed a regulatory change that would let doctors apply for special access to the drug, also called diacetylmorphine, and offer it to patients as they see fit.
“A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic relapsing opioid dependence,” reads a Health Canada media release.
Since December 2014, a small group of specific patients has had access to prescription heroin at a clinic called Crosstown in Vancouver’s Downtown Eastside.
Three times a day, 110 patients can visit the clinic at set times and receive an intravenous dose of heroin under the supervision of nurses. The treatment is paid for by taxpayers and operates under Providence Health Care, the regional authority that also runs St. Paul’s Hospital.
The 110 people are only allowed access to the drug via a court injunction. They are previous participants in a clinical trial. Upon that study’s conclusion, they were essentially grandfathered into the program pending the resolution of a legal challenge.
If the proposed regulatory changes pass, it would eliminate the need for that legal challenge and open the door for people outside of the group of Crosstown patients to gain access to prescription heroin via their doctors.
A consultation period of 30 days is now underway.
Dr. Scott MacDonald is the lead physician at Crosstown Clinic who oversees the heroin maintenance program there.
"This is good news," he said in a telephone interview. "There are going to be more people having access to diacetylmorphine as a safe, effective, and cost effective treatment."
MacDonald however added the proposed regulations are only a "good first step". He noted the bureaucratic requirements for a doctor to prescribe heroin would remain arduous.
The idea behind heroin maintenance is harm reduction, MacDonald explained.
He pointed to studies that show patients enrolled in a heroin-maintenance program will have less negative interactions with police, greater access to medical treatment, and a new degree of stability that can help them improve other areas of their lives, such as housing and family relations.
"These people are involved in a chaotic lifestyle and an illicit drug trade that supports organized crime and general chaos for the community," he said. "It is important that we engage everybody in care that is using illicit opioids. We need all the tools in the tool kit, whether that is methadone, suboxone, hydromorphone for some, and diacetylmorphine or prescription heroin for the small number of people that need that."
The treatment is only recommended for chronic addicts who have previously failed with traditional forms of rehabilitation such as abstinence and methadone.
For the 110 patients receiving prescription heroin at Crosstown, the average number of years they have been addicted to opioids is 26.6 years. The average number of times they have failed with a traditional treatment is 11.4.
MacDonald estimated that if heroin maintenance could be administered without bureaucratic restrictions, the number of Vancouver residents for which the treatment would be appropriate would not exceed 500.
The court challenge was launched in March 2014 when Providence Health Care and five long-time heroin addicts filed a lawsuit against the Canadian government in an effort to secure diacetylmorphine as a legal means of managing addiction.
That action was in response to a regulatory change that former health minister Rona Ambrose enacted in October 2013. That month, she closed what she described as a “loophole”, barring clinicians from applying for special access to administer drugs such as heroin, cocaine, and ecstasy (MDMA).
Canadian doctors had never prescribed those drugs on a regular basis. But at that time, Vancouver’s heroin-maintenance program at Crosstown was gaining attention. Doctors were also beginning to write diacetylmorphine prescriptions for patients who had cycled out of the academic trial, and moving to make the treatment available to addicts who were not enrolled in earlier studies.
Doug King is a lawyer with Pivot Legal Society, the group representing the five plaintiffs in their lawsuit against the federal government. In a telephone interview, he said the regulatory change could lead the group to drop its court action.
“We’re happy,” he told the Straight. “We expect we’ll get the change in regulations that we are asking for in our lawsuit, and that will, essentially, be a victory for us.
“The point of the lawsuit was to nullify the regulation change that was made by the Conservative government and bring it back to the way it was,” King continued. “And that is essentially what they are doing here.”
Libby Davies was the member of parliament representing Vancouver East from 1997 to 2015. During those years, she repeatedly called for the government to legalize heroin as a means of reducing overdose deaths and improving the lives of addicts.
In a telephone interview, Davies placed the benefits of prescription heroin in the context of recent deaths attributed to fentanyl. She noted that drug, which is often sold as heroin but is much more dangerous, is killing an average of 64 British Columbians every month this year.
"People don't know what they are taking," she told the Straight. "So to have a prescribed program where people are in the health-care system, to me, that is the critical thing."
B.C. Health Minister Terry Lake voiced his support for Crosstown’s heroin-maintenance program in a release back in October 2013.
“We have to think outside of the box sometimes,” he said. “I know that the thought of using heroin as a treatment is scary, but I think we have to take the emotion out of it and let science inform the discussion.”
Health Canada's May 13 release notes prescription heroin has been available in other jurisdictions for some time, including Germany, the Netherlands, Denmark, and Switzerland.