Five-milligram pills of Oxycodone. (AP Photo/Keith Srakocic, File)

Give severely addicted drug users injectable medical-grade heroin, guideline says

CMAJ article outlines best practices for innovative treatment that’s been lacking in overdose crisis

A national research group recommends that health-care providers offer injectable medical-grade heroin or other prescription drug to severely addicted patients if oral medication has not worked to reduce cravings for people who could die from toxic street drugs.

Dr. Nadia Fairbairn, an addiction specialist at St. Paul’s Hospital, said a guideline published Monday in the Canadian Medical Association Journal outlines best practices for innovative treatment that has been lacking during an overdose crisis that claimed 4,460 lives in Canada last year.

“I think we really are going to need to think about how history’s going to look back on this era where we’re losing so many Canadians to a totally preventable cause like opioid fatalities,” said Fairbairn, the lead investigator for the Canadian Research Initiative on Substance Misuse, a research consortium.

Key recommendations in the guideline include the use of the injectable opioids diacetylmorphine, or pharmaceutical-grade heroin, and hydromorphone for patients who shoot up illicit opioids and have not responded to the most effective oral treatments — methadone and buprenorphine.

The Crosstown Clinic in Vancouver is the only facility in North America that provides diacetylmorphine, which is imported from Switzerland, as well as hydromorphone, another safer substitute for heroin recommended by the initiative, which consists of 32 members including Canadian health-care practitioners, opioid users and their families.

The Vancouver-based Study to Assess Longer-term Opioid Medication Effectiveness, published in 2016 in the Journal of the American Medical Association Psychiatry, found injectable hydromorphone and diacetylmorphine are equally effective at treating severely addicted heroin users who don’t respond to oral therapy. It included 202 patients.

An earlier study, the North American Opiate Mediation Initiative, which took place in Vancouver and Montreal between 2005 and 2008, suggested diacetylmorphine is an effective treatment for chronic heroin users when methadone does not work.

The recommendations are a blueprint for health-care practitioners on screening patients who would benefit from injecting the two injectable opioids under medical supervision, said Fairbairn, who is also a research scientist at the BC Centre on Substance Use.

Hydromorphone is also provided at a limited number of other clinics in B.C., some of which provide pills that users crush before injecting.

Dr. Scott MacDonald, the lead physician at the Crosstown Clinic, said the heroin substitute is available at about 10 clinics across Canada for chronic injection-drug users.

He said 125 patients are registered to inject diacetylmorphine at Crosstown, and 25 people are given hydromorphone.

READ MORE: How to talk to kids about B.C.’s overdose crisis

The rigorous program requires patients to inject at the facility under medical supervision three times a day at an annual taxpayer-funded cost of about $27,000 per patient, MacDonald said.

Overall societal costs would be higher if chronic drug users continued committing crimes to get their fix, raising policing levels and using health-care resources from overdosing or getting infections from used needles, he said.

“If we’re able to show that a new treatment is both more effective and more cost-effective it should be expanded. That should be an easy decision for health-care decision-makers, just looking solely at the evidence.”

The Canadian Press

Like us on Facebook and follow us on Twitter

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Comments are closed

Just Posted

In photos: Penticton Speedway celebrates opening weekend

Despite having to turn away roughly 700 cars, organizers celebrating a successful weekend of racing

RCMP investigate bear spray assault outside Penticton pub

Two patrons assaulted with bear spray outside Nanaimo Avenue pub

Coalmont woman airlifted after ATV crash

Off-road vehicle swerved to miss oncoming traffic

Summerland campground to provide COVID-safe accommodations for temporary farm-workers

The managed seasonal worker campsite will be located within a separated area of Peach Orchard Municipal Campground

QUIZ: A celebration of dogs

These are the dog days of summer. How much do you know about dogs?

B.C. records 31 new cases, six deaths over three days due to COVID-19

There are 166 active cases in B.C., 16 people in hospital

Police issue warning after baby comes across suspected drugs in Kamloops park

The 11-month-old girl’s mother posted photos on social media showing a small plastic bag containing a purple substance

B.C. highway widening job reduced, costs still up $61 million

Union-only project scales back work to widen Trans-Canada

Kamloops man pleads guilty in vehicle-ramming incident that injured a Mountie

Adam Hibbert was arrested following a collision during a police pursuit on May 26, 2019

Greater Victoria nanny pleads guilty to child porn, sexual interference charges

Johnathon Lee Robichaud pleaded guilty to slew of sex crimes

Victoria man dies after skydiving incident on Vancouver Island

34-year-old had made more than 1,000 jumps

BC Wildfire Service to conduct night vision trials for helicopters in South Okanagan

This technology could assist with future firefighting operations

Most Read