In Legalizing Prescription Heroin, Canada Supports Ethical, Evidence-Based Medical Care
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In Legalizing Prescription Heroin, Canada Supports Ethical, Evidence-Based Medical Care

The decision comes at a critical time in the national opioid overdose crisis.

Prime Minister Justin Trudeau's government has approved prescription heroin. Photo by Alex Guibord from the Torontoist Flickr pool.

Prime Minister Justin Trudeau’s government has approved prescription heroin. Photo by Alex Guibord from the Torontoist Flickr pool.

Last Tuesday, the federal government continued to quietly unravel the “hard on drugs” policies of the previous administration by legalizing medically prescribed heroin. Through an application to a Special Access Programme administered by Health Canada, any physician in the country can now treat heroin-dependent patients with diacetylmorphine, the drug’s active ingredient.

As the opioid overdose crisis continues to ravage North America, the announcement was met with international fanfare—and misinformation. No, Canada has not legalized heroin for the general public, as the myth-busting website Snopes had to clarify. Doctors filing requests for the medication under the new legislation must prove they are handling “cases where traditional options have been tried and proven ineffective.”

Still, this policy represents a major breakthrough in ensuring that people who use drugs are afforded the same rights and protections as any other patient in our health care system.

Here are a few more reasons why we should be excited about it:

It can dramatically increase the success rate of addictions treatment.

People transitioning off of heroin are typically prescribed buprenorphine or methadone, which provide relief from withdrawal symptoms without the accompanying high. While this approach works for many, it’s ineffective for 10 per cent of people with chronic heroin dependence.

The Study to Assess Long-Term Opioid Maintenance Effectiveness (SALOME) examined 202 chronic heroin users who were not benefiting from conventional treatments. It showed that patients treated with injectable diacetylmorphine were much more likely to stay in treatment and reduce their use of illegal drugs and other illegal activities than patients treated with oral methadone.

It’s far safer than the alternatives.

Chronic heroin use is connected to collapsed veins, infection of the heart lining and valves, constipation and gastrointestinal cramping, and liver or kidney disease, and it also increases the risk of pulmonary complications.

But the vast majority of the drug’s adverse health effects are the result of contaminated doses, poor injection practices, or the associated lifestyle risks that come with street drug use. Under direction and supervision from medical professionals, the risks of heroin use are substantially mitigated. Medically pure heroin that’s administered with clean needles won’t lead to HIV, abscesses, or related infections. And as its users won’t have to scramble to pay the exorbitant price of street drugs, they’re far less likely to engage in dangerous behaviour to procure them.

It’s a humane way of addressing addiction, which also acknowledges the factors that lead to drug abuse.

Supervising and supporting people who use drugs in a safer manner demonstrates compassion for their circumstances, strengthens their connections to the health care system, and encourages them to recover on their own terms.

Many people with addictions are stuck in incredibly unstable environments, in which drugs may be their only relief. Demanding that people drastically alter their behaviour in order to receive health care treatment usually leads to them avoiding treatment entirely. But providing them with accessible and non-judgmental services can grant them the support and stability they need to make healthier decisions on a long-term basis.

It’ll save us money.

If the argument that people should be treated with basic respect doesn’t sway you, how about some potential savings on your tax bill?

The costs for Vancouver’s similar Crosstown prescription program have been estimated at $21,000 per client per year. If these clients were denied access to the program, and instead given jail time or medical care for their subsequent health issues, the costs would be around $35,000 per year.

It reduces the negative impacts of open drug use in our communities.

Opponents to harm reduction approaches often warn of the potential danger to our communities. Hell, the federal Conservatives even titled their anti-supervised injection site legislation the Respect for Communities Act.

At the beginning of the SALOME study, researchers created a dedicated phone line for complaints about disruptions caused by the study or its participants. They even formed a neighbourhood advisory committee to draw attention to the phone line’s existence. It never received a single call.

Similar prescription programs have been available for years in communities in Britain, Denmark, Germany, the Netherlands, and Switzerland—all of which reported significant decreases in crime as a result of implementing the services.

Morality really doesn’t belong in our health system.

Confronted with an abundance of data that points to the effectiveness of these programs, those who oppose harm reduction tactics and services have instead chosen to stake out the moral high ground.

Whether or not you think that taking illegal drugs is inherently immoral, we can probably all agree on the immorality of creating environments where vulnerable people are likely to experience harm. In defending the Respect for Communities Act, then-health minister Rona Ambrose said that instead of harm reduction, she favours “harm elimination.” Well, sure Rona, we all do. But in the face of the real, existing harm faced by people who use untested drugs on the street, choosing to implement policies that deny them access to medical care won’t eliminate shit.

Ambrose further stated that “[then-prime minister Stephen Harper] and I do not believe we are serving the best interests of those addicted to drugs and those who need our help the most by giving them the very drugs they are addicted to.”

“Belief” has no place in policy (especially when these beliefs are repeatedly proven unfounded), and beneficial medical care should not be granted or withheld based on moral judgments. Medicine is prescribed by health care professionals based on their expertise and on their patients’ needs and choices, not on the opinions of politicians.

This will demonstrably save lives.

This decision comes at a serious time of crisis for Canada. Toronto’s medical officer of health found the reported number of people dying from overdoses in the city increased by 41 per cent from 2004 to 2013, a number which will likely continue to rise alongside increases in fentanyl contamination. Of the 173 heroin checks that Vancouver’s Insite facility performed in July, 90 per cent tested positive for the deadly opioid.

We know that people don’t become heroin addicts in a vacuum. But we’ve been letting them die in vacuums of our own making. The government’s move is a strong step forward in recognizing that data, not discomfort, should be informing our country’s drug policies.