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

Just Posted

LETTER: Priority should be given to locals accessing Golden Ears park

Maple Ridge residents should be able to reserve new day passes ahead of out-of-towners: one local

When life gives you lemons…

Maple Ridge kids make the most of summer by setting up lemonade stand

SHARE: Rainy days of summer in Maple Ridge still a sight to behold

Send us your photo showing how you view Maple Ridge or Pitt Meadows, and it could be featured soon

FURTHER UPDATE: Body removed from Maple Ridge hotel after large police presence

A large contingent of Mounties were at the Art Infiniti Hotel Friday afternoon and evening

Flames honour their best from last season

Maple Ridge’s Amsler the MVP and team scoring leader

53 new COVID-19 cases, no new deaths cap off week of high infection rates in B.C.

Roughly 1,500 people are self-isolating because they either have COVID-19 or have been exposed to it

VIDEO: Internet famous Yukon-based bhangra dancer explores Vancouver Island

Gurdeep Pandher spreads joy through dance, forms cross-cultural connections amid pandemic

Unofficial holidays: the weird and wonderful things people celebrate around the world

On any given day of the year, there are several strange, silly or serious holidays to observe

Fraser Valley Bandits advance to CEBL Championship Game

Bandits post comeback 76-75 win over Hamilton Honey Badgers in Saturday’s semifinal

IHIT on scene of suspicious early-morning fire on rural Mission property

Entrance to Gunn Avenue property cordoned off while investigation takes place, updates coming

Moving on: Tanev scores 11 seconds into OT as Canucks oust Wild

Vancouver beats Minnesota 5-4 to move into first round of NHL playoffs

Gene editing debate takes root with organic broccoli, new UBC research shows

Broccoli is one of the best-known vegetables with origins in this scientific haze

VIDEO: U.S. Air Force pilot does fly-by for B.C. son amid COVID border separation

Sky-high father-son visit plays out over White Rock Pier

3 Vancouver police officers test positive for COVID after responding to large party

Union president says other officers are self-isolating due to possible exposure

Most Read