Vancouver clinic turns long-time addicts from prescription heroin to abstinence

This article was written in partnership with Cited Podcast for a program distributed on NPR stations across the United States. Listen to a related radio documentary about the fentanyl crisis and a controversial fix for addiction.

Two long-time addicts have taken an unconventional road to sobriety: prescription heroin.

They are the first participants in a Vancouver experiment to graduate to abstinence, according to the program’s operator, Providence Health Care.

Since November 2014, Crosstown Clinic in the Downtown Eastside has seen a select group of addicts visit three times a day to receive clean, legal, and regulated doses of heroin, paid for by B.C. taxpayers. It’s the only facility like it in North America.

Critics describe the program as giving up on people. Among its notable detractors are former prime minister Stephen Harper and his health minister, Rona Ambrose, who tried to shut it down. Supporters respond by noting prescription heroin is proven to stabilize entrenched addicts’ lives, helping them secure employment and housing, reduce tendencies to commit crimes, and improve their health.

Now those two patients constitute another measure of success.

They’re part of a growing number who have used diacetylmorphine—the medical term for heroin—to transition to abstinence or to stop using needles in favour of opioids taken orally.

“There are a couple that are now abstinent,” Crosstown’s physician lead, Dr. Scott MacDonald, told the Straight. “So this is not an end-of-the-line treatment. It is a way for people to get some stability, regain some health, get their minds clear, and then move on to other things.”

Since enrolling at Crosstown, 25 former injection-drug users have transitioned to oral therapies, according to statistics provided by Providence Health Care. Nine transitioned to oral hydromorphone and 16 to methadone, Suboxone, or slow-release oral morphine.

Dianne Tobin was the first to go completely free of drugs. On the phone from her family’s home in Bridgewater, Nova Scotia, she recounted how she did it.

Over the course of four decades, Tobin told the Georgia Straight, she tried and failed many times to get clean, sometimes putting herself through terrible bouts of withdrawal. Each time, she returned to heroin that she was forced to buy on the street.

Then, on March 15, 2006, Tobin became one of the first Vancouver residents to receive prescription heroin as part of an academic study at Crosstown. A similar research project followed, beginning in 2011. Then, in November 2014, she began receiving heroin-assisted treatment (HAT) outside of those experiments.

Her life became increasingly stable and, in late 2016, Tobin transitioned to oral hydromorphone. For the first time since she was 17 years old, she spent an extended period of time without using needles. Next, with the help of her doctor at the clinic, she lowered her hydromorphone intake in increments, from 425 milligrams per day to 125 per day and then to a 75-milligram dose just twice a week. On December 5, she visited Crosstown for the last time.

Tobin remained in the Downtown Eastside for a short while after that. But the fentanyl crisis began to get to her.

“I’d hear somebody else died, somebody else died,” she explained. “You didn’t have time to grieve. You couldn’t go to the memorials. I would have been at a memorial every day. I just finally got tired of it and I told Doc, ‘I’m going home, where I don’t have to hear ambulances all day.’ ”

Last year, 922 people in B.C. died of an illicit-drug overdose. The synthetic opioid fentanyl was detected in about 60 percent of those deaths.

Today it’s only a select group of 91 entrenched addicts that is allowed to access prescription heroin. At Crosstown, patients have used opioids for an average of 26.6 years and failed with traditional treatments such as methadone an average of 11.4 times.

In response to the arrival of fentanyl and a sharp increase in overdose deaths, MacDonald said he wants to lower the threshold for access to diacetylmorphine.

“If you’ve had a resuscitation attempt with Narcan and you’ve got opioid-use disorder, you should be offered treatment on demand,” he said. “For some people, that will be methadone or Suboxone. But if they won’t accept one of those, we should be offering injectable treatment.”

In a telephone interview, Health Minister Jane Philpott said she supports a medicalized model for prescription heroin. Asked what the Liberal government has done to facilitate the expansion of heroin-assisted treatment beyond Crosstown, she responded: “This isn’t anything that the federal government can do on its own, because the delivery of health-care services falls largely into the jurisdiction of provinces.”

But MacDonald argued that it is the federal government that must act to facilitate wider access to prescription heroin.

“It’s a complicated process to prescribe, dispense, and store diacetylmorphine,” he explained. “If it is going to be available, those regulations need to be streamlined and some of the obstacles removed. This [diacetylmorphine] needs to be produced, stored, just like any other pharmaceutical or opioid.”

With files from Sam Fenn, Gordon Katic, and Alexander Kim.

This article was written in partnership with Cited Podcast for a program distributed on NPR stations across the United States. Listen to a related radio documentary about the fentanyl crisis and a controversial fix for addiction.