Canada's federal health agency intends to open up legal access to heroin as a treatment for chronic opioid abuse, a move that is already being heralded by doctors who have fought to make the drug a legitimate option.
The announcement comes as the country struggles with a rise in illicit drug overdoses and an especially dramatic spike in those involving fentanyl, which is roughly 100 times more potent than heroin. The province of British Columbia declared a public health emergency in April after fentanyl overdoses killed 200 people in just three months and neighboring Alberta last week made naloxone, an opiate overdose antidote, available without a prescription.
"There are people across this country who are suffering from severe opiate use disorder that need access to this," said Dr. Scott McDonald, who has been fighting for years in British Columbia to make heroin a legitimate treatment option for those with severe opiate addictions. "A small number, but a significant one."
The new proposed a regulatory amendment by Health Canada would allow diacetylmorphine, or pharmaceutical grade heroin, to be considered under its Special Access Program (SAP).
Under the SAP, clinical experts assess requests for emergency access to drugs for people who have serious or life-threatening conditions, where traditional treatment methods haven't worked, are unsuitable or unavailable.
Prescribing heroin to tackle opiate abuse is already legal in a number of other countries, like Germany, the Netherlands, Denmark, and Switzerland, for those patients who haven't responded to conventional treatment options, like methadone and buprenorphine.
In 2014, the Providence Crosstown Clinic in Vancouver's Downtown Eastside, became the first in North America to legally prescribe pharmaceutical grade heroin to patients outside of a clinical trial. After the clinic's Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) was over, showing positive results, the clinic's doctors applied for permission to continue prescribing the drug to the participants.
In September, 2013, Health Canada approved the request, but Rona Ambrose — then federal health minister and now interim leader for the Conservative party — intervened, introducing new regulations that made diacetylmorphine a restricted drug and stopped doctors from prescribing anything on the list of restricted drugs.
Providence, along with their 202 trial participants, launched a constitutional challenge and were granted an injunction that allowed the clinic to offer medical heroin to the patients until the issue was resolved.
McDonald, the lead physician at Crosstown, said Health Canada's decision is a "welcome announcement," calling pharmaceutical-grade heroin a "safe, cost-effective, intensified treatment that saves lives."
While shooting up on the street often involves the illicit drug trade and organized crime, taking heroin in a controlled environment "gets [users] off the street and out of that destructive cycle of acquisition crime or sex trade work in order to get their fix," he said.
"You also don't know what you're getting [on the street] — it's a mixture of compounds," he said, adding that this is what leads to overdoses and death. In contrast, what the clinic has been offering is more pure, prepared in a pharmaceutical lab, meaning it's sterile and predictable.
McDonald said the mental and physical health of those in SALOME improved with the prescriptions, allowing doctors to take care of their associated chronic diseases and mental health issues.
"The drug itself attracts people into care, reduces their cravings, and reduces their illicit heroin use," he explained. "The other health benefits follow."
The government has invited stakeholders and members of the public to take part in a 30-day consultation period before the proposed regulatory change takes effect.
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