Canada Is Now Prescribing Heroin to Fight Addiction

Heroin addicts in Canada can now get their fix with a doctor's prescription. As of September 13, doctors who apply for a permit from Canada's Special Access Program can prescribe diacetylmorphine, or pharmaceutical grade heroin, to severely addicted patients.

Canada has been especially progressive in legislation that oversees addiction, treating it as an illness rather than a moral failure. In 2003, Vancouver became home to the first ever SIF, or supervised injection facility, where heroin users can bring their own stash and shoot up with sterile needles in a clean, safe environment.

And the policies could pave the way for global changes. Now, New York's city council just approved a study of supervised injection facilities in the city, while in Ithaca the mayor also proposed to open a SIF.

Not just any heroin user can go to a doctor to request a prescription under Canada's new program. The Canadian government requires that doctors at Vancouver's Crosstown Clinic need to verify that "traditional options have been tried and proven ineffective" in getting the patient to quit his or her habit, as the Washington Post reported.That means other addiction treatment methods, such as rehabilitation or prescribing methadone, must have failed first.

Though patients must meet fairly high demands, including going to the clinic two to three times a day for injections, the program's dropout rate is low. With a prescription, and an accurate notion of the quality and dose they're using, patients can administer heroin in a supervised medical facility to get their fix. The idea is that incrementally, patients will work with a physician to decrease their dose and eventually break the habit.

"Canada is taking steps to move forward drug policies that are rooted in science and evidence-based practices," Alyssa Aguilera, co-executive director of VOCAL-NY, a nonprofit advocate for low-income New Yorkers affected by strict drug law enforcement, told Motherboard. She said Canada's new policy is promising, focused more on restorative rather than punitive measures, unlike the American Drug War.

Canada's policy recognizes the physical need that addicts have, as well, she said. "Withdrawal is really real and can have really detrimental effects on people's bodies. This is a method to combat that and help people in a way that's more medically sound." And experts say it's not realistic to go from all to nothing overnight, especially when addicts have a build up of the drug in their bodies. Moreover, if they quit cold turkey and their tolerance plummets, they're more vulnerable to overdose if they relapse and try to shoot up what used to be their regular dose.

Between 2005 and 2008, researchers at the Providence Healthcare Crosstown Clinic in Vancouver conducted the North American Opiate Medication Initiative (NAOMI), a trial in which the clinic gave prescription heroin to patients. After a year, as compared to patients treating their addiction with methadone, 62 percent of patients were more likely to stay in treatment, and 40 percent were less likely to take illegal drugs or commit crimes to support their drug habit.

In a follow up trial between 2011 and 2015, Study to Assess Longer-term Opioid Medication Effectiveness, researchers treated patients either with heroin, or hydromorphone, three times a day at the clinic.

Together, these pioneering studies made possible Canada's new legislation, acknowledging that incremental reductions in heroin use works better for some patients than do other methods. The new policy is, of course, controversial. "Our policy is to take heroin out of the hands of addicts and not put it in their arms," said Colin Carrie, a conservative member of the Canadian Parliament, who opposes the policy.

But for supporters, this policy provides what for many is a last resort. Scott MacDonald, lead physician at the Crosstown Clinic, supports the policy, told the Post that many of his patients are long-term users who have tried and failed to quit with other treatments. "Our goal is to get people into care," said MacDonald.

By gradually reducing dose, providing a clean fix, and supervising for overdoses, Canada's new policy just might save lives.