Tag Archives: heroin

Health Canada proposes regulation change to permit prescription heroin for severe addicts

At Crosstown Clinic in the Downtown Eastside, Dr. Scott MacDonald oversees patients with severe addictions who are given prescription heroin and hydromorphone to stabilize their lives. Travis Lupick photo.
At Crosstown Clinic in the Downtown Eastside, Dr. Scott MacDonald oversees patients with severe addictions who are given prescription heroin and hydromorphone to stabilize their lives. Travis Lupick photo.

Canadian doctors could soon be allowed to offer patients prescription heroin as a method of treatment for a severe addiction to opioids.

Today (May 13), Health Canada proposed a regulatory change that would let doctors apply for special access to the drug, also called diacetylmorphine, and offer it to patients as they see fit.

“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,” reads a Health Canada media release.

Since December 2014, a small group of specific patients has hadaccess to prescription heroin at a clinic called Crosstown in Vancouver’s Downtown Eastside.

Three times a day, 110 patients can visit the clinic at set times and receive an intravenous dose of heroin under the supervision of nurses. The treatment is paid for by taxpayers and operates under Providence Health Care, the regional authority that also runs St. Paul’s Hospital.

The 110 people are only allowed access to the drug via a court injunction. They are previous participants in a clinical trial. Upon that study’s conclusion, they were essentially grandfathered into the program pending the resolution of a legal challenge.

If the proposed regulatory changes pass, it would eliminate the need for that legal challenge and open the door for people outside of the group of Crosstown patients to gain access to prescription heroin via their doctors.

A consultation period of 30 days is now underway.

Dr. Scott MacDonald is the lead physician at Crosstown Clinic who oversees the heroin maintenance program there.

“This is good news,” he said in a telephone interview. “There are going to be more people having access to diacetylmorphine as a safe, effective, and cost effective treatment.”

MacDonald however added the proposed regulations are only a “good first step”. He noted the bureaucratic requirements for a doctor to prescribe heroin would remain arduous.

The idea behind heroin maintenance is harm reduction, MacDonald explained.

He pointed to studies that show patients enrolled in a heroin-maintenance program will have less negative interactions with police, greater access to medical treatment, and a new degree of stability that can help them improve other areas of their lives, such as housing and family relations.

“These people are involved in a chaotic lifestyle and an illicit drug trade that supports organized crime and general chaos for the community,” he said. “It is important that we engage everybody in care that is using illicit opioids. We need all the tools in the tool kit, whether that is methadone, suboxone, hydromorphone for some, and diacetylmorphine or prescription heroin for the small number of people that need that.”

The treatment is only recommended for chronic addicts who have previously failed with traditional forms of rehabilitation such as abstinence and methadone.

For the 110 patients receiving prescription heroin at Crosstown, the average number of years they have been addicted to opioids is 26.6 years. The average number of times they have failed with a traditional treatment is 11.4.

MacDonald estimated that if heroin maintenance could be administered without bureaucratic restrictions, the number of Vancouver residents for which the treatment would be appropriate would not exceed 500.

The court challenge was launched in March 2014 when Providence Health Care and five long-time heroin addicts filed a lawsuit against the Canadian government in an effort to secure diacetylmorphine as a legal means of managing addiction.

That action was in response to a regulatory change that former health minister Rona Ambrose enacted in October 2013. That month, she closed what she described as a “loophole”, barring clinicians from applying for special access to administer drugs such as heroin, cocaine, and ecstasy (MDMA).

Canadian doctors had never prescribed those drugs on a regular basis. But at that time, Vancouver’s heroin-maintenance program at Crosstown was gaining attention. Doctors were also beginning to write diacetylmorphine prescriptions for patients who had cycled out of the academic trial, and moving to make the treatment available to addicts who were not enrolled in earlier studies.

Doug King is a lawyer with Pivot Legal Society, the group representing the five plaintiffs in their lawsuit against the federal government. In a telephone interview, he said the regulatory change could lead the group to drop its court action.

“We’re happy,” he told the Straight. “We expect we’ll get the change in regulations that we are asking for in our lawsuit, and that will, essentially, be a victory for us.

“The point of the lawsuit was to nullify the regulation change that was made by the Conservative government and bring it back to the way it was,” King continued. “And that is essentially what they are doing here.”

Libby Davies was the member of parliament representing Vancouver East from 1997 to 2015. During those years, she repeatedly called for the government to legalize heroin as a means of reducing overdose deaths and improving the lives of addicts.

In a telephone interview, Davies placed the benefits of prescription heroin in the context of recent deaths attributed to fentanyl. She noted that drug, which is often sold as heroin but is much more dangerous, is killing an average of 64 British Columbians every month this year.

“People don’t know what they are taking,” she told the Straight. “So to have a prescribed program where people are in the health-care system, to me, that is the critical thing.”

B.C. Health Minister Terry Lake voiced his support for Crosstown’s heroin-maintenance program in a release back in October 2013.

“We have to think outside of the box sometimes,” he said. “I know that the thought of using heroin as a treatment is scary, but I think we have to take the emotion out of it and let science inform the discussion.”

Health Canada’s May 13 release notes prescription heroin has been available in other jurisdictions for some time, including Germany, the Netherlands, Denmark, and Switzerland.

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This article originally appeared in print and online at Straight.com on May 13, 2016.

Red tape blocks B.C. health officials’ proposals for dealing with fentanyl overdoses

Naloxone kits that are used to reverse the effects of an opioid overdose area vailable at 88 health-care sites around B.C. Toward the Heart photo.
Naloxone kits that are used to reverse the effects of an opioid overdose area vailable at 88 health-care sites around B.C. Toward the Heart photo.

Provincial health officials are discussing a variety of interventions that could be deployed in response to a recent surge in overdoses linked to the synthetic opioid fentanyl. However, several of those ideas remain blocked by legal or bureaucratic challenges.

During an August 11 conference call, Jane Buxton, harm-reduction lead for the B.C. Centre for Disease Control, said one suggestion is to open drug “checking” sites where people could bring illicit narcotics to be analyzed without fear of police persecution.

“The possibility of testing street drugs, that is something that would be of value,” Buxton said. “Currently, there is no way to do that in the legal framework that we have and there is no test available.” (A test for fentanyl does exist but it requires specialized equipment and a trained technician.)

On August 5, the Straight reported that the Vancouver Police Department would not oppose such drug-testing.

Joining Buxton on the call was deputy provincial health officer Bonnie Henry. She said she would like naloxone, a drug used to counter opioid overdoses, made available without a prescription in B.C. That decision has to be made by Health Canada, she noted, and though it is being discussed, it is unlikely to come soon.

Although ambulances in B.C. are equipped with naloxone kits, police and RCMP officers still respond to calls without them, Henry added. In a subsequent telephone interview, she explained that there is concern about officers carrying needles and the risks those can pose. In the United States, some police departments equip their officers with an intranasal form of naloxone, but that has not been approved in Canada.

Buxton said she would also like to see an expansion of harm-reduction services in B.C. But again, she noted, there are barriers such as opposition from the federal Conservative government.

Buxton maintained the province is advancing these ideas, especially in the case of naloxone. But she conceded that it is “frustrating”.

According to an August 11 warning issued by the B.C. Coroners’ Service, so far in 2015 it has detected fentanyl in 66 overdose deaths. That’s up from 13 in 2012 and on track to surpass the 90 seen in 2013.

This article originally appeared in print and online at Straight.com on August 12, 2015.

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Vancouver prescription heroin program hits a snag that interrupts treatment for some patients

The supervised injection room at Providence Crosstown Clinic, where patients are given prescribed heroin as a means of managing their addictions. Travis Lupick photo.
The supervised injection room at Providence Crosstown Clinic, where patients are given prescribed heroin as a means of managing their addictions. Travis Lupick photo.

Perhaps to no one’s surprise, it turns out that supplying heroin to people without breaking the law is not an easy or a simple thing to do.

Since November 2014, a program run out of a clinic in Vancouver’s Downtown Eastside has done just that—that is, giving chronic addicts free prescription heroin, otherwise known as diacetylmorphine. But there was recently a hitch in the supply chain, which effectively put the harm-reduction initiative called heroin maintenance on hold.

David Lefebvre, a spokesperson for its operator, Providence Health Care, told the Straight that “due to a permit issue”, doctors at Crosstown Clinic had to transition patients to another drug called hydromorphone, a synthetic derivative of morphine. He noted that for some addicts, the change has been a struggle.

“This is the first time in North America that any clinic has provided diacetylmorphine to people who have chronic heroin addictions and that is a process that is extremely complex,” he said in a telephone interview.

Lefebvre explained that Crosstown was forced to begin transitioning patients roughly two weeks ago and hopes to have a majority of those people back on diacetylmorphine when a shipment of the drug arrives from a supplier in Europe “sometime in mid-September”.

“The reality is, the movement of diacetylmorphine is governed internationally, so it is so much more complex than people realize,” he explained. “It is not just a national issue with Health Canada, it is not just a national issue with the Office of Controlled Substances. It is also an international issue.”

Lefebvre said where exactly in the supply chain this problem occurred is in transit at a point across the Atlantic Ocean.

“The permit system in Europe takes six to eight weeks for drugs to be exported to Canada,” he said. “That results in delays that affect our ability to provide diacetylmorphine to our patients. Due to this time lag, Crosstown has had to transition some patients onto hydromorphone.”

Lefebvre cautioned that even after Providence receives its next shipment of diacetylmorphine in mid-September, the same problem could occur again.

“We are expecting continued issues with regard to supply due to this importation time lag,” he conceded.

Lefebvre acknowledged that for many long-term addicts, the transition off of heroin, even to another opiate such as hydromorphone, is not a painless experience. “We appreciate that this is challenging for them,” he said.

In past interviews, Lefebvre stressed that heroin-assisted treatment is only recommended as an appropriate intervention for individuals who have repeatedly failed with traditional therapies such as methadone.

In accordance with a B.C. Supreme Court injunction granted in May 2014, to be eligible to receive prescription heroin, a patient must have participated in the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), an academic program that began at Crosstown Clinic in 2011. The average SALOME participant has failed with traditional treatment for opioid dependence an average of 11 times.

The number of eligible past SALOME participants is 202. Of that group, Lefebvre said doctors have written diacetylmorphine prescriptions for 120 patients. He declined to specify how many of that group were affected by disruptions in the supply chain.

Health Canada has steadfastly opposed Vancouver’s prescription heroin program. The province’s Health Minister, Terry Lake, has stood behind regional authorities and supported it.

This article originally appeared online at Straight.com on August 5, 2015.

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Ottawa blocking supervised injection site that would save lives, Victoria councillor says

SFU researcher Ehsan Jozaghi looked at the numbers and found that opening a supervised-injection facility like Insite in B.C.'s capital would save lives and save the city.
SFU researcher Ehsan Jozaghi looked at the numbers and found that opening a supervised-injection facility like Insite in B.C.’s capital would save lives and save the city.

A supervised-injection facility similar to Vancouver’s Insite would be a good deal for Victoria taxpayers, a new study by researchers with Simon Fraser University concludes.

“We would not only be saving people’s lives but also reducing costs to the health-care system,” said Ehsan Jozaghi, the paper’s lead author. “I think people should move away from ideology and just look at the numbers.”

Specifically, researchers found that by opening one supervised-injection facility in Victoria, the city would avoid 13 new HIV cases annually and prevent 2.3 fatal overdoses each year.

The paper, published by the journal Urban Geography on July 3, notes that one HIV infection costs Canada’s health-care system an estimated $210,000 per year and that the loss of one life is valued at roughly $979,000.

Victoria mayor Lisa Helps has spoken in support of harm-reduction programs. “I will work hard to make sure that we have a safe consumption site in this city,” she said during a candidates’ debate ahead of last November’s civic election.

Since then, Victoria has included supervised-consumption services in its strategic plan for 2015 to 2018.

In a telephone interview, Coun. Marianne Alto said she’s optimistic the city will open its first supervised-injection facility before the end of that period.

“We can do a lot of the prep work,” she said. “But, ultimately, we are going to come to a point where we are going to hit a brick wall and that is called the federal government.”

Alto explained that Bill C-2, the Respect for Communities Act, which passed into law in March this year, has made it significantly more difficult for regional health authorities to obtain the permissions required to open a facility similar to Vancouver’s Insite.

Nevertheless, she said stakeholders will meet in the fall to begin the long process required to open such a facility.

The Dr. Peter Centre in Vancouver’s West End operates an unsanctioned supervised-injection room. It applied for federal exemptions required to operate legitimately in February 2013 and is still waiting for an answer on that application.

Health Canada did not make a representative available for an interview by deadline.

In related news, a July 12 bulletin issued by the B.C. Centre for Disease Control (BCCDC) states there has been a surge in drugs found to contain fentanyl, a synthetic opioid that’s more toxic than heroin.

A province-wide study found 29 percent of participants tested positive for fentanyl and, of those drug users, 73 percent said they did not consume fentanyl knowingly.

“Fentanyl-detected illicit drug overdose deaths in British Columbia increased from 5% of total illicit drug deaths in 2012 to over 25% in 2014,” the BCCDC warns.

It notes it is not just heroin that is testing positive for fentanyl but virtually every street drug, including cocaine, methamphetamine, ecstasy, and cloned prescription pills such as those sold as OxyContin.

This article originally appeared in print and online at Straight.com on July 29, 2015.

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