Despite the fact that heroin is the deadliest drug worldwide, Canada just approved prescription heroin on Friday, September 16. With deaths from heroin-related overdoses skyrocketing, this news is baffling at first glance. But, it’s in fact a radical, strategic move in an attempt to combat the ongoing opioid crisis.
A Harm Reduction Strategy
In the face of just-say-no approaches to drug abuse and failing attempts at complete sobriety—particularly for opioid addicts—many organizations and communities have adopted harm reduction practices. Harm reduction aims to reduce the negative consequences associated with drug abuse. It uses strategies to make drug use safer, meet drug users “where they’re at” in terms of reducing their use versus insisting upon total abstinence, and address conditions that go along with drug use.
In Canada, the move to approve prescription heroin comes from health experts and policymakers who want to diminish the risk associated with intravenous drug use. Now, doctors in Canada will be able to prescribe diacetylmorphine—a.k.a prescription-grade heroin—for the treatment of “chronic relapsing opioid dependence.”
Canada’s Special Access Programme (SAP) provides doctors with access to drugs that aren’t available on the market. Specifically, such drugs can be used for the treatment of patients with serious or life-threatening conditions, when “conventional therapies have failed, are unsuitable, or unavailable.”
In terms of prescription heroin, Canadian health officials say that it’s shown some effectiveness as a treatment of opioid dependence for certain, exceptional cases in scientific trials. Evidence-based practices are essential to creating the best treatment plans. Prescription heroin is now one more option available to physicians caring for treatment-resistant addicts in Canada.
Supervised Heroin Injection Sites?
There is strong evidence supporting Canada’s decision to approve prescription heroin. Researchers established the Crosstown clinic, a supervised injection site in Vancouver, to study possible impacts of such a program on the health of heroin users. There’s no other program like it in Canada, but eight European countries have tried a similar approach.
The physician who developed the program, Dr. Scott MacDonald, said it’s shown huge success by providing prescription heroin to certain users—52 addicts under a court-ordered exemption. In order to qualify, participants must be long-time heroin users who have tried to quit drugs more than once. In most cases, standard treatments like methadone and detox have failed these users.
Qualified users can come to the clinic 2-3 times a day. They’re provided with a clean syringe and drugs to inject, at no cost to them. There is a medical staff on-site, which monitors the clinic and intervenes with naloxone in the event of an overdose.
MacDonald says these programs are “a kind of last resort,” in which heroin addicts “come to us every day rather than stay on the streets.” These addicts are still using heroin, but “that engagement and retention in care is a significant benefit.” With any treatment program, one of the most difficult aspects is keeping people engaged in the recovery process and motivated towards positive change.
Even more difficult is helping addicts to develop stability in their lives. Through programs like MacDonald’s, many people who formerly frequented jails or hospitals have now reconnected with families, gone back to school, and maintained stable employment. In the scope of the recovery process, these strides are considered “major successes.”
The goal of supervised injection sites is to reduce the risks of opioid abuse and intravenous drug use, without forcing addicts to stop using drugs. At an injection clinic, addicts can satisfy their drug dependency without the risk of overdose and without resorting to crime to obtain drugs.
One of the first successful heroin-assisted treatment programs was established in Switzerland. The research reported fewer drug-related crimes, drops in street heroin use among the addicts being treated, and lifestyle improvements like stabilized housing and employment., In Ithaca, NY, the mayor hopes to open a similar program, which would be the first of its kind in the U.S.
Prescription Heroin as Medicine-Based Treatment
Many people argue that it’s dangerous and counterintuitive to make heroin available to users at these clinics—and now to prescribing doctors. Why give addicts the very drug they can’t stop using?
The rationale is similar to that of other medicine-based treatment approaches. Many medications have become mainstreamed in the treatment of opioid dependence and opioid withdrawal symptoms, like methadone and buprenorphine. Many people are also opposed to these medications because—though they tame cravings and don’t produce the same euphoric high when taken as prescribed—they are still opioids.
Yes, some users have misused and abused methadone and buprenorphine. However, many more users have abused a host of other prescription medications. Both of these opioid-dependence medications are recommended by the Centers for Disease Control and Prevention as well as the World Health Organization, based on scientific evidence supporting their effectiveness.
But, while methadone and buprenorphine treatments are effective for some, a small portion of opioid users have failed repeatedly to respond to these methods. This small, unresponsive group inspired the exploration of heroin-assisted treatment. Results from research trials have shown that it can be an effective alternative treatment, to establish stability where all other treatments have failed these users.
The Grim Reality
In the face of a deadly opioid epidemic, harm reduction approaches have emerged to do just what their name implies: reduce the harm caused by opioid abuse and lower the rising death toll. Health experts and policy makers are witnessing the failure of more ideal outcomes—like complete, sustained sobriety through addiction treatment.
This controversial move by Canada reflects the grim reality, that heroin is addictive to such an extent that many users continue to shoot up despite the grave dangers and consequences. Supervised injection sites at least protect users from the dangers of living and using on the streets, offering them:
- Pure, regulated heroin, rather than heroin laced with fentanyl or elephant tranquilizer;
- Clean needles, rather than shared needles that are potentially-infectious with HIV or hepatitis;
- A safe place with medical assistance in the event of overdose, rather than any of the number of places where a user could be hurt, taken advantage of, or overdose and die.
It is unlikely that harm reduction approaches like these are preferred by anyone. But, supervised injection sites and Canada’s recent approval of prescription heroin are by no means intended to provide a free-for-all for addicts.
Like other medication-assisted treatments, heroin-assisted treatment is meant to assist struggling addicts in the recovery process and is only appropriate for a small group of drug users. With heroin-assisted treatment in particular, it is only intended to be a last resort for a slim margin of treatment-resistant users.
Adapting Treatment Approaches and Goals
For that slim margin of people with treatment-resistant drug problems, more “radical” approaches like heroin-assisted treatment have provided stability where nothing else has seemed to work.
Some health experts and policy makers feel that asking drug users to “get clean” or to quit using drugs entirely isn’t always feasible. In some cases, after decades of heroin abuse, or a lifetime of trauma, or countless failures to say clean, an insistence on total abstinence can make treatment all the more difficult. For now and for some cases of opioid addiction, the focus is on harm reduction and stability is the new goal.