British Columbia, Canada, has had a heroin problem for years. Statistics are hard to come by, but in 2008, a former user described use of the drug in the province as an "epidemic," and a 2010 BBC story called Vancouver, the province's largest city, the "Drug Central of North America." But a new strategy in the fight against addiction and the host of societal problems that come with it is emerging: let doctors prescribe addicts heroin so they get the drug they need without resorting to crime. Studies have shown this approach can help many longtime users, but the Canadian gonvernment wants it shut down.
Prescription heroin is used in some European countries, including Switzerland, Germany, Denmark, and the Netherlands, but it's been a long time coming to North America. The first Canadian study that tested the effectiveness of giving addicts heroin under the supervision of doctors was the North American Opiate Medication Initiative (NAOMI), which started in 2005. It eventually recruited 251 addicts in Vancouver and Montreal who had unsuccessfully attempted to kick smack numerous times. A control group was given methadone, which is commonly prescribed to heroin addicts so they can wean themselves off hard drugs.
The results, published in the New England Journal of Medicine in 2009, showed that injectable heroin—known in medical-speak as diacetylmorphine—was a far more effective and efficient treatment than methadone in getting users out of the vicious and costly cycle of crime, infection, overdoses, and hospital visits that are a way of life for those in the grips of long-term, hardcore addiction. Compared to those trying to kick heroin using methadone, participants used street drugs less often, committed fewer crimes, and were employed more often, more connected to their families, and straight-up happier. A "cost of illness" analysis from 2000 found that severely addicted individuals can cost society over $43,000 per year, so getting addicts off the streets and into roles as members of productive society is good for all of Canada.
Dave Murray participated in the study and went on to found the NAOMI Patients Association in 2011. But in 2005 he was in his 50s and addicted seemlingly for life.
“I’m living in the Downtown Eastside of Vancouver in a single-room-occupancy hotel, I’m down on my luck and I’m down to nothing," he told me over the phone. "I’m dealing drugs to support my habit and committing crimes. Doing various horrible things that I don’t even want to talk about. I often describe the addiction like if you can picture a dog chasing his tail, round and round and round and then finally it falls asleep. And then when it wakes up, and it’s back to chasing its tail around. That’s the stress of addiction. That’s the life of an addict.”
Dave said the first time he tried to get clean was back in 1971, in Montreal, where he was first prescribed methadone. Over the next three decades he attempted to kick the habit again and again, but with the final goal of abstinence seemingly impossible to achieve, he wound up getting back on street drugs.
The regularity of the NAOMI study is what started to stabilize Dave’s life. The stress of chasing his tail was removed and it was like a weight was lifted. “It cleared my brain, it gave me an opportunity,” he said. For 12 months, Dave got a morning, lunch, and evening fix under the supervision of a medical staff, and that regularity allowed him to focus on other things. But when the experiment wrapped up, Dave's only option was to go back on methadone.
“Methadone was the drug we’d have to have failed at when we actually went into the program in the first place!" he told me. So that was quite a dilemma for people, and in my case, I went through the program and I didn’t want to go back to it.”
So he returned to the familiar lifestyle of a street addict—heroin, treatment, heroin, more attempts to get clean, heroin—all the while barely keeping it together. But throughout his struggle, he kept running into people in the neighborhood who he’d met in NAOMI. They were confused and pissed off. Why couldn’t they continue treatment when it had obviously worked?
“To think that [the government] spent $3 million [Canadian] dollars on the NAOMI study and then sat on our hands with that information really started to get me mad," he said. "We needed an exit strategy. I mean if we’re going to do this—discover all these positive results and then not do anything for anybody… It’s immoral and it’s wrong.”
In 2011, Providence Health Care, the nonprofit responsible for NAOMI, got a second study approved by the government. Called the Study to Assess Long-Term Opioid Maintenance (SALOME), it's similar to NAOMI, the difference being that rather than comparing the effectiveness of heroin and methadone, the goal is to determine whether hydromorphone, a legal painkiller, is as helpful a treatment as heroin.
Representatives from the SALOME program discussing its various benefits to Vancouver.
As participants exit the study, however, they face the same problem that Dave and others faced in 2008—if they've made progress in getting their lives in order while on prescription heroin, what are they supposed to do when that treatment is no longer available to them?
After months and years of lobbying by doctors and lawyers, Health Canada, the government department responsible for public health, finally gave its approval to let 16 addicts, the ones who have been utterly unable to wean themselves off the drug, to continue receiving prescribed heroin. The decision falls under the auspices of Canada’s Special Access Program, which “allows practitioners to request access to drugs that are unavailable for sale in Canada" when patients have "serious or life-threatening conditions" and "conventional therapies have failed, are unsuitable, or are unavailable.”
Even though the decision is narrow and based on solid medical evidence, the current Conservative government slammed the ruling. Rona Ambrose, the Minister of Health, said in a press release that, “This decision is in direct opposition to the government’s antidrug policy and violates the spirit and intent of the Special Access Program. I am taking immediate action to ensure… this does not happen again.”
The Conservative Party has also started a petition that reflects its knee-jerk hard-line stance on drugs—who cares whether prescribed heroin has the potential to improve lives, the most important thing is that heroin is evil and addicts should be treated like criminals.
“I was shocked to learn today that Health Canada has approved the application to give heroin to addicts—against the wishes of our elected government,” the petition says, before going into aggressive fearmongering. “If the NDP or Liberals are elected in 2015, you can bet they would make this heroin-for-addicts program permanent.” Our opponents are the parties of junkies!
Of course this attitude is nothing new—in 2008 the federal government tried to shut down the country’s only safe injection site, though that effort eventually failed thanks to a Supreme Court ruling.
Scott Bernstein, a lawyer with the Pivot Legal Society who has been working on behalf of SALOME to get Health Canada's approval for prescribed heroin, is ready for a scrap if Conservatives attempt to shut the program down.
“I’m interested to see if they try, but we would legally challenge that," he told me. "Nothing’s going to be happening without us going in there and making sure that the rights of our clients are protected and policies aren’t put in based on a stigma about drug users.”
As Dave Murray can attest to, even though giving heroin to heroin addicts is a controversial strategy, in some cases it works better than anything else. What's more, prescribing someone heroin and giving it to them in a safe, legal environment for a year, then taking that stability away from them when a study ends is downright cruel.
“If you’re going to pull someone out of the ditch, you don’t pull them halfway out and leave them on their own," he said. "You’ve got to pull them out and really start helping them, and you’ll be amazed how resourceful these people are. I mean, think about if you had to go out there and come up with a hundred or two hundred bucks every day without a job, you’re quite a resourceful character—if you can give them some other direction to use that resourcefulness to become successful in some other field other than obtaining enough money to buy their heroin every day, I think you’d be amazed how far some people could go if you gave them a hand.”
Follow Dave on Twitter: @ddner
This post originally appeared at VICE.