In Cutting Edge Move, Canada to Allow Prescription Heroin

This article was produced in collaboration with AlterNet and first appeared here.

Health Canada announced Friday that it is proposing new regulations to allow access to prescription heroin under its Special Access Program (SAP). That program allows for emergency access to drugs for serious or life-threatening conditions when conventional treatments have failed or are unsuitable.

"A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic, relapsing opioid dependence. Diacetylmorphine is permitted in a number of other jurisdictions, such as Germany, the Netherlands, Denmark, and Switzerland, to support a small percentage of patients who have not responded to other treatment options, such as methadone and buprenorphine," the statement said.

The move is yet another reversal of hardline Conservative drug policies by the Liberal government headed by Prime Minister Justin Trudeau, which was elected last fall. The Trudeau government has pivoted sharply away from Conservative positions in favor of mandatory minimum drug sentences and against marijuana legalization, and now is moving to undo Conservative efforts to block the limited use of prescription heroin.

Canadian scientists had laid the groundwork for prescription with the North American Opiate Medication Initiative (NAOMI), which first tested "heroin-assisted maintenance" in Vancouver a dozen years ago, and which was followed by the Study to Assess Long-Term Opioid Maintenance Effectiveness (SALOME) between 2005 and 2008. SALOME examined whether giving hard-core heroin users heroin was more effective than giving them methadone.

SALOME showed that the users in the study were more likely to stay in treatment, reduce other illegal drug use, engage in fewer other illegal activities and have better physical and mental health outcomes if given heroin than if given methadone. But when that study ended in 2008, researchers were faced with the ethical dilemma of cutting off the patients whose lives were being improved by prescription heroin.

The doctors began applying for, and receiving, permission under the Special Access Program, and Health Canada approved those applications in 2013. But that infuriated the Conservatives, and then-Health Minister Rona Ambrose introduced new regulations to bar doctors from prescribing "dangerous drugs" such as heroin, cocaine, and LSD.

Former SALOME participants launched a constitutional challenge to the ban and in 2014 won a temporary injunction giving them the right to continue to receive prescription heroin while the case was being decided. Now, with Health Canada's move, the federal government will no longer attempt to block prescription heroin.

That was good news for the Pivot Legal Society, which argued the case for continuing the prescriptions, and for Providence Health Care, in whose Crosstown Clinic in Vancouver's Downtown Lower East Side the heroin was administered.

"Allowing access to diacetylmorphine, or medical heroin, to patients who need it, ensures that life-saving treatments get delivered to vulnerable people suffering from chronic opioid use," the two groups said in a joint statement.

Canada is leading the way on cutting edge responses to heroin addiction in North America. In addition to the groundbreaking NAOMI and SALOME studies, which cannot be replicated in the US under current law and regulations, Canada has also had safe injection sites operating in Vancouver for more than a decade. We still don't have any of those in the US.