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

‘Snowmaggedon 2020’ has passed, but 20-30 milimetres of rain expected Friday

Residents should brace for rain and clear drains to prevent localized flooding

What happens in the Cowichan Valley when an earthquake strikes

When an earthquake does happen, will the Cowichan Valley be ready for it?

Exploring life, the afterlife, and near death experiences with Dr. Lynn Echevarria

Echevarria will deliver a talk to the LRCA Seniors Centre Tuesday, January 21 at 1:30 pm

Winter storm warning now in effect for Island’s east coast

Environment Canada issues new weather warning late Wednesday afternoon

Town of Ladysmith snow removal crews prepared to respond to overnight snowfall

10 to 15 centimetres of snow are expected for Ladysmith overnight Tuesday into Wednesday morning

Kids across Canada more at risk of hospitalization from flu this season: doctor

Dr. Theresa Tam said influenza B does not usually peak until February or later

BC Ferries hybrid ships arrive in Victoria on Saturday

The battery-operated vessels will take over smaller routes

Theft victim confronts suspects with baseball bat on Vancouver Island

RCMP in Nanaimo seek to identify of two people alleged to have used a stolen credit card

Closed mills, housing surge support a positive forecast for lumber industries

B.C. lumber producers have closed mills accounting for 18% of province’s capacity, RBC report says

Good Samaritan pays part of rent for B.C. woman facing eviction in can-collecting dispute

Zora Hlevnjak, 76, supplements her pension by collecting cans and receiving public donations

Kelowna’s ‘Baby Mary’ finds biological parents after more than 30 years

Geneologist and DNA test helped her connect with her biological parents

Kelowna hotel to award couples for baby-making with Nooner deal

The deal includes a free stay every Valentine’s Day for the next 18 years

Clerk bruised, traumatized after armed robbery at Nanaimo liquor store

Few details on male suspect in Wednesday incident, says Nanaimo RCMP

One last blast of winter tonight for parts of the Island before temperatures on the rise

A snowfall warning is in effect Friday including east Vancouver Island.

Most Read