Doctors in Vancouver are administering 120 severe heroin addicts with legal doses of the drug this week, marking the first legal dosage of heroin outside of clinical research in North America.
Twenty-six of the patients had previously participated in a clinical research trial conducted by the Providence Crosstown Clinic and the University of British Columbia that focused on treating the most severely addicted heroin users.
Providence, which is part of a network of Catholic health centers in Canada, is one of a number of research groups around the world experimenting with treating heroin addicts by prescribing them medical-grade heroin to reduce their risk of overdose, infection, and death. In countries such as the UK, Germany, and the Netherlands, heroin-based treatments have been available for several years.
Methadone is traditionally prescribed to help wean addicts off of heroin, and it was also used in the Canadian clinical trial, but 15 to 20 percent of patients fail to respond to the treatment. Most of the patients in the medical trial had unsuccessfully tried traditional treatments an average of 11 times.
David Byres, vice president of acute clinical programs at Providence Health Care, told VICE News that that prescription heroin treatment is a last resort for people with the most serious heroin habits.
"The intent was never that this would be a first line of treatment," he said. "We will certainly keep up with deterrent and education and prevention — that all needs to continue — but this is looking at people who are the most severely addicted."
During the clinical trial, patients were injected two or three times daily with a dosage of diacetylmorphine, the active ingredient in heroin. The treatment also involved providing patients with counseling and a medical plan that included gradually lowering their dosage of the drug so that they need less each day. Patients couldn't use illegal heroin while they were being treated, and their drug levels were regularly monitored during the program.
Byres noted that as the trial progressed, the patients' health drastically improved. Research from other trials around the world also showed that similar experimental procedures helped patients stabilize and turn away from illicit drug use, ultimately improving their lives, he said.
"Many who were homeless now have places to live. Some are thinking about employment activities," Byres said. "They have stopped all illicit activity leading to the drug use, whether that's crime or prostitution."
Doctors wanted to continue the treatment after the trial's conclusion in 2013, but the Canadian government moved to ban heroin prescriptions outside of clinical trials, and many of the trial's patients returned to illicit drug use. Some overdosed and died, according to Byres.
Providence and a group of patients went to court to fight the ban and received an injunction against it in May of this year. Adrienne Smith, a lawyer focusing on health and drug policy at Pivot Legal Services, a non-profit that is representing five patients in the lawsuit, told VICE News that the doses being administered this week are the result of that injunction.
Smith and her team argued that the Canadian government's ban on prescription heroin was violating the patients' constitutional rights to life, liberty, and security of person, and that the medicine should be made especially available to those whose lives are at risk.
"It will never be something that is dispensed by family doctors or drop-in clinics, but specialized healthcare with a specialist in addiction medicine," she said. "People won't be able to pop around the corner for their heroin."
The legal wrangling over the use of prescription heroin in Canada is ongoing. Providence and Pivot are scheduled to go to court to try and legalize the drug for all patients who may need it, but the trial is not scheduled to begin until next year at the earliest.
"We're working to make sure patients have continued access," Smith said. "If we're successful at trial, it's Pivot's hope that we will ensure access to prescription heroin for any patient in Canada for whom it is medically appropriate."
Though it might seem confusing to treat an addiction with an addictive substance, the point is to get patients to use in a safer way and increase their options for reducing the dependency.
"It's an interim step to get them to use more safely," Joshua Lee, a researcher in tobacco, alcohol, and drug use at New York University, told VICE News.
Lee noted that the Canadian model is unlikely to be adopted in the United States anytime soon because of Drug Enforcement Administration and Food and Drug Administration regulations that would prevent it from being applied in a medical setting. As a Schedule I substance under the Controlled Substances Act, heroin is classified as a drug with no currently accepted medical use and a high potential for abuse.
Heroin abuse is an escalating problem in the US, with usage increasing some 74 percent from 2009 to 2012, according to a recent Centers for Disease Control report. Deaths from heroin overdoses doubled between 2010 and 2012.
Photo via Wikimedia Commons