CHANGE FOR THE BETTER
New rules will help addicts
This week the government of Canada made a series of regulatory changes that allow applications to be made for access to medical heroin as a form of emergency addiction treatment. The changes open the door for the continuation of life-saving treatment to vulnerable patients who are struggling with opioid addiction.
It’s a reversal of former federal health minister Rona Ambrose’s decision in October 2013 to restrict access to what is known as assisted heroin treatment. The change signals the federal government’s willingness to consider innovative forms of addiction treatment that are supported by scientific evidence.
For many, the idea of providing someone who is addicted to a drug with that very same drug as a form of treatment may seem counterintuitive. But it’s not — think nicotine-based smokingcessation treatments for smokers. Heroin-assisted treatment has proven to be a highly effective option when other treatment options have failed. For this small subset of individuals, it has meant their lives are no longer dominated by how and where they will find and fund their next fix.
Access to assisted heroin treatment means these patients can avoid the many dangers inherent with obtaining and injecting a substance only available on the streets. No more getting robbed, ripped off or beat up. No more risk of injecting a drug whose potency is unknown, whose ingestion could lead to an overdose or death.
That itself has become an ever-increasing risky proposition. The rise of fentanyl, often disguised as heroin but many times more potent, has led to a staggering number of deaths across the country for addicted and recreational users. In Ontario it is now the leading cause of death by opioid overdose. Since 2011, fentanyl-detected deaths increased by nearly seven times in B.C., while in Alberta they increased more than 20 times over that same period.
Instead of facing this life-and-death dilemma, patients on assisted heroin treatment receive pure medical-grade diacetylmorphine, adminis- tered under the supervision of their physician. A visit to a health care clinic replaces the death, violence and abuse the addicts often face on the streets.
This stability resonates through other aspects of the patient’s life: transitioning from homelessness to stable housing, reconnecting with family and community, finding employment. It could also mean moving onto other forms of treatment.
That is why it was so confounding when the former federal Conservative government decided to make diacetylmorphine impossible to access, even in the addiction-treatment context. They essentially circumnavigated Health Canada’s evidencebased decision to allow these patients access to the treatment, preventing the delivery of life-saving treatment to vulnerable addicts in the face of evidence demonstrating its effectiveness.
Were it not for a court order granted by the Supreme Court of B.C. in May 2014, the participants in the SALOME research study wouldn’t have been able to even apply for special access to the treatment. Thanks to that court order, 121 patients were able to continue to access and receive assisted treatment.
Research from around the world, including here in Canada, has clearly demonstrated that under the right circumstances, heroin-assisted treatment can be an effective treatment. As a result, it’s now available in the United Kingdom, Switzerland, Germany, Denmark, and the Netherlands.
To be clear, the announcement from the federal government this week does not mean that heroin is suddenly available as a medical treatment to everyone in Canada. Access remains limited to those who apply through Health Canada’s Special Access Program (SAP) to access medications normally not available.
When it comes to treating addiction, our health care system must be given access to every effective tool, including heroin-assisted therapy. To deprive access to this treatment, particularly in the middle of a public health crisis that is causing hundreds of preventable deaths, would be nothing less than inhumane.