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

Just Posted

New location, new energy for The Good Earth

The Good Earth celebrated their grand opening in a new space on… Continue reading

Fernie Arts Co-op celebrates upgraded space with sale

The Fernie Arts Co-op was a busy place on Saturday, as they… Continue reading

Holiday Artisan Fair at The Arts Station showcases local talent

The Arts Station was bustling and alive with artisans, shoppers and live… Continue reading

Christmas cheer for charity

Tis the season of giving in the Elk Valley, as we see… Continue reading

Kootenay-Columbia MP talks throne speech, USMCA trade deal

Rob Morrison to open constituency office in Cranbrook at 800C Baker St. on Dec. 19

VIDEO: Success of wildlife corridors in Banff National Park has advocates wanting more

Demand for more highway protection escalated after seven elk were killed by a semi-trailer near Canmore

Sharks beat Canucks 4-2 to snap 6-game skid

Vancouver visits Vegas on Sunday

Fans sing Canadian anthem after sound system breaks at BMW IBSF World Cup

The Canadians in attendance made sure their team and flag were honoured on the podium

VIDEO: Fire destroys Big White Ski Resort chalet

Social media eulogies peg the property, nicknamed “The Pharamacy,” as both loved and hated

Prince George RCMP use bait packages to catch porch pirates over the holidays

First-in-Canada program with Amazon looks to combat parcel theft

Nanaimo mechanical engineer creates thief tracking program

Nanaimo Thief Tracking lets users plot and share information about thefts online

Mayor wants B.C. to institutionalize severely mental ill people who are homeless

Those suffering from mental health conditions, such as schizophrenia, need specialized care, mayor says

Five things of note from Trudeau’s mandate letters to his ministers

Some marching orders come from the Liberal Party’s campaign, while others are new additions

Most Read