As of today (September 7), Canadian doctors are allowed to offer patients prescription heroin as a method of treatment for a severe addiction to opioids.
Permission for the alternative therapy comes via a change to the Controlled Drugs and Substances Act. It permits doctors to apply under the federal special access program to write a prescription for diacetylmorphine, the pharmaceutical term for heroin.
The legislative change is not entirely new, but rather a return to old rules that existed before the former Conservative administration banned doctors’ access to diacetylmorphine in October 2013.
That month, former health minister Rona Ambrose closed what she described as a “loophole”, barring clinicians from applying for special access to administer drugs such as heroin, cocaine, and ecstasy (MDMA).
Now, Health Minister Jane Philpott has again revised the rules to essentially reopen the door that Ambrose closed.
Health Canada made no immediate announcement regarding the change. The news was revealed in a technical notice published in the federal government’s Canada Gazette publication. A statement Health Canada later emailed to media placed the decision in the context of rising numbers of drug-overdose deaths observed in recent years across Canada.
"Canada is currently facing an opioid overdose crisis, and we need to assist our healthcare providers in treating their patients, including those who are suffering from chronic relapsing opioid dependency," it reads. "Scientific evidence supports the medical use of diacetylmorphine for the treatment of chronic relapsing opioid dependence in certain individual cases. Health Canada recognizes the importance of providing physicians with the power to make evidence-based treatment proposals in these exceptional cases."
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.
Until today, the 110 people were 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. Today’s news means there is no longer any reason for that action to proceed and that prescription heroin can be made available to patients beyond the group of Vancouver patients.
In previous interviews with the Straight, Providence officials stressed that heroin-assisted treatment, or HAT, as it is also known, is only recommended for select patients.
For the 110 people receiving prescription heroin in Vancouver since December 2014, the average length of time 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.
Interviewed by the Straight last May, Dr. Scott MacDonald, the lead physician at Crosstown Clinic who oversees the heroin maintenance program, explained how prescription heroin fits alongside other harm-reduction policies like needle distribution.
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," MacDonald 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."
Health Canada explains its rationale for the change in the Gazette notice published today.
"There is a body of research supporting the use of pharmaceutical grade diacetylmorphine to treat a group of patients with opioid dependence who have not responded to other treatments," it reads. "A number of countries have allowed physicians to use diacetylmorphine-assisted treatment for these specific patients. Having access to diacetylmorphine will provide health practitioners with an additional treatment option to treat patients with opioid dependence who have not responded to traditional treatments. Treatment with diacetylmorphine in a comprehensive setting can lead to improved treatment outcomes and health benefits for these patients."
The legislative change is the latest move in a series that the new Liberal government has made to increase access to harm-reduction programs that were discouraged and obstructed under Stephen Harper’s former Conservative administration.
On September 1, Philpott said that she was open to the idea of reviewing legislation passed by the former Conservative government that makes it difficult for cities to establish supervised-injection sites for drug users.
Before that, on March 17, Health Canada granted permission to the Downtown Eastside’s supervised-injection facility, Insite, to operate for another four years. The former Conservative government only gave the facility permission to remain open for one year at a time.