The Canadian government approved the use of pharmaceutical-grade heroin to treat severe substance use disorders in Sept. 2016.
Through a program allowing physicians to request nonmarketed medications in special circumstances, doctors across Canada can now use diacetylmorphine — pharmaceutical-grade heroin — to treat patients who are unresponsive to conventional medication-assisted treatment.
“Treatment with diacetylmorphine in a comprehensive setting can lead to improved treatment outcomes and health benefits for these patients,” Health Canada, the government’s department of public health, wrote in Aug. 2016.
Health Canada justifies the implementation of the program as a necessary tool to combat the opioid-overdose epidemic. The program, first of its kind in North America, follows the footsteps of five European countries, where doctors use the medication to treat chronic pain and address relapsing opioid dependence. Several other countries in Europe have approved the drug for clinical research.
Medical Heroin Use — A Proven Track Record
From 2005 to 2008, a clinical trial called the North American Opiate Medication Initiative compared the effectiveness of methadone to that of diacetylmorphine. The study found that treatment involving medical heroin was more successful than standard methadone treatment. Researchers also advised that patients should receive heroin treatment in heavily supervised settings due to the addictive nature of the drug.
In April 2016, a four-year trial called the Study to Access Longer-term Opioid Medication Effectiveness compared diacetylmorphine and hydromorphone treatment. It revealed that hydromorphone, an opioid analgesic, could be used in place of prescription heroin in locations where the drug is not available.
In addition to these studies, a combined analysis of six randomized control trials in six countries revealed that prescription heroin had more positive results than regular treatment in treating severe opioid use disorders.
Crosstown Clinic in Vancouver, Canada, was the first health institution in North America to offer a heroin maintenance program despite the Canadian government’s ban on heroin-assisted treatment. The program was successful enough to win a constitutional challenge aiming to stop distribution of the drug, allowing Crosstown to provide diacetylmorphine-assisted therapy to 52 people under a court-ordered exemption.
The clinic’s rigorous treatment program requires patients to go in thrice daily to receive their injections, which poses a challenge for working individuals. However, the program has a low dropout rate and contributes to patients’ recovery journeys by easing their societal reintegration.
A Controversial Approach
Because of the addictive nature of heroin, not everybody is on board with heroin-assisted treatments.
“Our policy is to take heroin out of the hands of addicts and not put it in their arms,” said Colin Carrie, a Conservative member of the Canadian Parliament.
U.S. lawmakers and law enforcement expressed similar resistance.
In April 2016, The Associated Press reported that Susan Talamantes Eggman, a member of the California State Assembly, was pushing to allow drug users to have access to heroin, crack and other drugs at monitored facilities. Eggman hoped that this initiative would help diminish overdoses, but law enforcement disagreed because they feared it would worsen substance use disorders.
Asha Harris, spokesperson for the California State Sheriff’s Association, explained that Eggman’s proposal sends the wrong message about substance use and may make the government liable for civil issues.
Republican Assemblyman Tom Lackey agreed with Harris, stating that California was not ready for such a step. He said the state should explore other methods to control opioid addiction before resorting to heroin-assisted treatment.
“We need to discourage people, but we also need to help them,” said Lackey, “I just can’t support this because there’s a number of problems at this stage.”
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