Canadian doctors can now prescribe heroin to people with serious addictions to the drug.
This change is thanks to new regulations approved earlier this month by the Canadian government.
The government says this treatment will be limited to a small number of users “in cases where traditional options have been tried and proven ineffective.”
Doctors will need to apply to Health Canada — the country’s health department — for access to pharmaceutical grade heroin (diacetylmorphine).
Requests will be approved on a case-by-case basis as part of the government-run Special Access Programme.
Shift in approach
This new policy is part of a shift by Prime Minister Justin Trudeau’s government away from the previous Conservative government’s approach toward fighting drug addiction and misuse.
In April, the government also announced it will introduce legislation next year to legalize the sale of marijuana.
According to The Washington Post, some members of the Canadian Conservative party remain opposed to the use of prescription heroin as a treatment option for those with an opioid addiction.
Others welcome the change.
“It’s good that the federal government is considering the most vulnerable patients and people in Canada,” Dr. Scott MacDonald, lead physician at the Providence Crosstown Clinic in British Columbia, told Healthline.
The clinic, which is funded by the provincial government, has been using diacetylmorphine for several years to treat people with heroin addiction. Patients visit the clinic up to three times a day for injections of heroin from a nurse.
This is part of a special court-ordered exemption granted in 2014. The new regulations are expected to allow the clinic to expand its program.
Small number of users
But the government’s new stance will hardly open up the floodgates to people seeking prescription heroin.
This treatment is focused on the small minority of users who have tried and not been helped by standard treatments for opioid addiction, such as methadone and suboxone.
“Here in Vancouver we have a small number of people who have tried everything. That number may be 500 people,” said MacDonald. “We’re currently treating 150. Maybe someday we can treat 500.”
MacDonald says many of his patients have been using heroin for a long time — one for 50 years.
Long-term heroin use can have severe effects on the health of users, including an increased risk of collapsed veins, arthritis, and liver and kidney disease. Users also have a higher risk of becoming infected with HIV, hepatitis, or other infectious diseases.
In 2014 about 10,000 Americans died from a heroin overdose, according to the National Institute on Drug Abuse. The situation is similar in Canada.
“We need every option available,” said MacDonald. “This is a crisis. People are dying daily from opioid overdoses here in British Columbia and across the country.”
MacDonald says the goal of Crosstown’s program is to coax people who are addicted to heroin into treatment — and to keep them coming back.
For the people who might benefit from prescription heroin, it will still not be an easy route.
“When people are started on these treatments,” said MacDonald, “we need to acknowledge — and they need to accept — that this is going to be long-term treatment for most.”
As people get their lives back on track, some may switch to less-intensive treatments like methadone or suboxone. Others may be able to get off these drugs completely.
Long track record
While the new regulations in Canada are pushing the boundaries of how drug addiction is treated in the country, the use of prescription heroin as a treatment is not new.
This treatment has been available in Europe for many years, including almost 100 years in the United Kingdom.
Several randomized clinical trials — such as one published in 2009 in the New England Journal of Medicine — have also been conducted looking at the effectiveness of this treatment.
“The results [of these clinical trials] were all unanimous — showing benefit. There is very good and substantial evidence that this is safe, effective, and cost-effective,” said MacDonald. “I don’t understand the delay in implementing it.”