When all other treatment options fail, society is left with one big question: how can we save the lives of chronically addicted heroin addicts? That is the question that Health Canada- Canada’s board of health officials- have asked themselves. The solution? Prescription Heroin.
In September 2016 Canadian Prime Minister, Justin Trudeau, approved a new regulation which will allow doctors to apply for a permit to prescribe medical- grade heroin to those with whom other attempts at treatment have been ineffective. The criteria includes such factors as the number of times these chronic heroin users have been through treatment, treatment methods they have tried, age, length of use, socioeconomic factors such as criminal history, or homelessness, and risk for committing crime or spreading blood borne disease. The persons who meet this criteria will then be admitted to a program at Vancouvers Crosstown Clinic, to receive heroin-assisted treatment (HAT). They are provided a maintenance dose of heroin up to three times daily, which must be used under the supervision of the clinical staff.
While the approach may seem controversial, the results may surprise you. Initial findings show that the patients receiving the medical heroin were more likely to follow their treatment program than those receiving methadone, or suboxone supplements. This includes therapy, social services, and health assessments. Initial findings show the patients are in greater physical and mental health than when they were using street drugs. A percentage of the patients have even been able to find employment and housing, and have stopped committing crimes. Even the financials show promise, as the cost per patient to provided heroin assisted treatment averages $25,000/yr, as opposed to the $48,000 per person average for health and criminal fees for active street users.
While the results of the initiative are still short term in the Crosstown Clinic, the program is modeled after similar efforts across Europe, with Switzerland being the flagship for HAT. The Swiss Government began a similar project in 1994, which is still running today, and considered extremely successful. An article published in 2017, which looks at the results of the Swiss HAT program over a 20 year period noted a significant decrease in heroin related deaths, use of other illegal drugs, and criminal activity. Perhaps most importantly, the study found that there was a reduction in the initiation of new users. Other positive outcomes of the program have included a stabilization in the amount of heroin being used, as opposed to a rise which is often the case in methadone related treatment models, as well as more users seeking help through all methods of treatment.
However, while the results are positive for the most part, there are certainly drawbacks to this type of treatment. For example, users are required to inject at the clinic site under observation, meaning trips to the clinic several times daily. This can greatly impact quality of life, and interfere with the ability to find and keep a job, or deal with many of lifes responsibilities. And unlike methadone programs, few clinics practice take home dosing- meaning, giving a client in good standing measured doses to take home, eliminating some of the hassle of frequent trips. Those that do, require long term stability with the HAT program before such luxuries are afforded. Other negative factors include the very specific and narrow criteria for qualifying, as well as the limited availability of prescription-heroin to physicians, due to safety regulations.
Certainly there is more time needed before the efficacy of Canada’s Heroin- assisted Treatment program is known. There are always factors to consider when introducing a program into a new social and economic environment, but officials for the Crosstown Clinic are cautiously optimistic at this point.
One thing is clear across all of these programs, which is that in spite of all the controversy, it is sometimes necessary to take the most extreme approaches in order to save the lives of the extremely addicted.
Heroin-assisted treatment in Switzerland: successfully regulating the supply and use of a high-risk injectable drug. (2017, January 10). Retrieved June 15, 2017, from http://www.tdpf.org.uk/blog/heroin-assisted-treatment-switzerland-successfully-regulating-supply-and-use-high-risk-0
Saving lives with heroin in Canada. (n.d.). Retrieved June 15, 2017, from https://news.vice.com/story/canada-is-prescribing-heroin-to-treat-opioid-addiction