Providing drugsfor drugusers

Controversial program showing positive results inVancouver

At Providence Crosstown Clinic inWest Hastings, Vancouver, chronic drug users line up three times per day for a shot of medical-grade heroin as part of an effort to battle the opioid crisis in one of the hardest-hit places in the country.

The program is controversial, but as the crisis worsens, conversations around its effectiveness are beginning to crop up in othermajor centres. Places likeToronto. Montreal. And Lethbridge.

At their June 11 Lethbridge City Council meeting, Coun. JoeMauro brought up the issue during a discussion to hold a future Community Issues Committee meeting regarding the opioid crisis in the city.

“You knowwhat I’mhoping?” he asked. “I’m hoping that the experts tell us that we (should) start providing the drugs for (drug users). Because then they can go in there and do it. Apparently that’s what they do in Europe.

“They don’t take the needles out. You go in, you get your fix, you do it there. And then there will be no needles.”

Maurowas referring to a treatment program which has been going on in Europe and at the Crosstown Clinic for years.

The clinic is the only one inNorth America providing diacetylmorphine, or medical-grade heroin, and the legal analgesic hydromorphone in a supervised injection setting.

The treatment operates as a stronger version of acceptedOpioid AgonistTreatment therapies such as methadone or Suboxone, and intended for the roughly 10 per cent of opioid users who do not respond to other treatments. It is not to be confused with a supervised injection facility that provides the space for illicit drug use.

“It’s not a safe consumption service at all,” said Barry Andres, executive director, AlbertaHealth Services Addiction andMentalHealth. “It’s a physician-led medical program. It’s essentially an expansion of the current opioid agonist programs for individuals who have not found that level of intervention sufficient for them.”

“It’s providing amore potent level of substance for chronic substance userswho have unsuccessfully tried every other treatment,” said Stacey Bourque, executive director for ARCHES. “It allows them to consume it in the method of their choice.”

In the 1990s, itwas becoming clear that methadone treatmentswere not effective treatment for all opioid users.

British doctors had been able to prescribe small amounts of heroin since themid-1920s.

Dr. ScottMacDonald, physician lead at the Crosstown Clinic, said changes to the national drug policies in Switzerland in the 1990s and the success of prescribed heroin treatment in that country turnedNorth American researchers onto the idea.

Prior to the current program, two studies were done at the clinic beginning in 2005.

North America’s first heroin assisted treatment study was called the North American Opiate Medication Initiative, or NAOMI, and was a test to see if heroin assisted therapy benefitted people suffering from chronic opiate addiction who have not benefitted from other treatments.

Enrolment began in 2005, and treatment concluded in 2007. The study took place in both Vancouver and Montreal, and confirmed supervised prescribed heroin as a safe and effective treatment for people who were not benefitting from established treatment.

Further, it led to a surprise in terms of the use of hydromorphone as an effective treatment as a small number of users were supplied with hydromorphone instead of diacetylmorphine.

“The 25 people who were receiving hydromorphone were unable to tell what drug they were getting,” said MacDonald, noting researchers were surprised by the results.

“These were experienced drug users. In NAOMI, they had an average of 17 years of drug use.”

The results of those hydromorphone results led to the Study to Assess Longer-term Opioid Medication Effectiveness, or SALOME, fully comparing hydromorphone with diacetylmorphine.

Hydromorphone is readily available in Canada and is easier to secure. Because of this, it is part of a pilot project scheduled for this fall in Calgary and Edmonton — and could be made available in Lethbridge at some point.

MacDonald said data collected on the issue shows the use of both drugs reduce societal costs over the lifetime of the user, as well as mortality and crime.

“Everybody here has tried the other treatments,” he said.

Using medical-grade heroin is not an end-of-the line treatment.

Some of the patients at the Crosstown Clinic have been able to step back into less-intensive programs.

The clinic has seen about 20 per cent of its patients return to more traditional treatment methods.

While overdoses do occur at the site, they are very rare: During the six-month injection phase of the SALOME study, there were about 88,000 treatments.

Nurses intervened with oxygen or naloxone 14 times.

“We’re providing a safe, sterile, predictable treatment,” said MacDonald.

“If someone is using an illicit substance they have no control over what that is. Often, the illicit stream of opioids people access is poisoned.”

MacDonald said oxygen or naloxone is administered about once per month.

“We’ve seen many lives transformed. And they’ve been protected from death.”

MacDonald said the treatment needs to be made available to between 2,000 and 3,000 people in B.C.

“They’ll be protected,” he said. “Societal costs will go down. Crime will go down. The burden that we’re moving onto our first responders will be reduced.

“It is a tremendous advantage for the individual and for society at large.

“This is a chronic, manageable disease, just like diabetes or high blood pressure.

“If we take that approach, some people will require more intensive treatments — a small number — and we need the full continuum of treatments.”

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