Pubdate: Thu, 27 Nov 2014
Source: Georgia Straight, The (CN BC)
Copyright: 2014 The Georgia Straight
Author: Travis Lupick


STARTING THE WEEK of November 23, doctors will administer prescription
heroin to a select group of patients in Vancouver.

It will be the first time that heroin, or diacetylmorphine, is given
to patients anywhere in North America outside of an academic study.

"For this group, the addiction is so severe that no other treatment
has been effective," said David Byres, vice president of acute
clinical programs at Providence Health Care. "The goal is

The harm-reduction program will be run out of Providence Crosstown
Clinic in the Downtown Eastside. In a telephone interview, Byres
emphasized that heroin-assisted treatment is only recommended as an
appropriate intervention for individuals who have repeatedly failed
with traditional therapies such as methadone.

In accordance with a B.C. Supreme Court injunction granted in May
2014, to be eligible a patient must have participated in the Study to
Assess Longer-term Opioid Medication Effectiveness (SALOME), an
academic program that began at Crosstown Clinic in 2011. Byres noted
that the average SALOME participant has failed with traditional
treatment for opioid dependence an average of 11 times.

That group consists of 202 people. Of that group, Byres said, doctors
have written diacetylmorphine prescriptions for 120 participants.
However, only 26 will begin receiving treatment next week because so
far diacetylmorphine shipments from Europe via Ottawa have only
arrived for that many.

Byres explained that for each patient, a physician must not only write
a prescription but must also submit an application to the federal
Special Access Program (SAP). Only after an application is approved in
Ottawa will Crosstown Clinic receive a patient's diacetylmorphine.

In a separate interview, Dr. Scott MacDonald, physician lead at
Crosstown Clinic, said it is his experience that patients are not
taking diacetylmorphine to get high but merely to function normally.

"It is a difficult therapy to take," MacDonald said. "People need to
come to this clinic three times a day in order to get their

Patients will only receive a dose of diacetylmorphine if they visit
the clinic at set times in the morning, afternoon, and evening,
MacDonald continued. There are eight groups of patients and,
therefore, eight different times for each dose. Each group has only a
10-minute window to enter the clinic.

Inside the clinic, the procedure remains highly controlled. Describing
a process originally designed for SALOME, MacDonald said staff confirm
a patient's identity and then assign them to a nurse who performs an
initial assessment. If an individual is deemed well enough, they
proceed to the injection room and receive their dose of
diacetylmorphine as well as a syringe and other equipment required for
intravenous drug use. They have 10 minutes to administer the drug.
Finally, there is a waiting area where patients remain under
observation for a short time before they are permitted to leave the
clinic. The entire process takes 30 minutes or less.

MacDonald emphasized the clinical nature of the program. He noted that
patients walk out of Crosstown Clinic shortly after injecting
diacetylmorphine, unlike depictions of heroin use in movies where
users nod off.

"This is safe, evidence-based treatment," he said. "When people first
come off the street, they are often unstable. But within a few weeks
here [SALOME]-and sometimes it's just days-we see a remarkable

According to Byres, the average cost of one patient's treatment is
$27,000 per year, an expense that is covered by Providence (and
therefore taxpayers). He noted that includes administration costs and
said it's a small part of that figure that goes to paying for the drug

Byres quickly pointed to a 2004 study published in the Royal Institute
of Public Health about heroin use in Canada. "The overall social cost
of one untreated opioid-dependent person in Toronto has been estimated
to be $45,000/year."

Byres also called attention to academic studies such as the North
American Opiate Medication Initiative (NAOMI), conducted in Vancouver
and Montreal, that suggests heroin-assisted treatment programs have
added benefits that stem from patients interacting with a nurse or
doctor instead of a dealer.

"When they come into the clinic, not only do they receive treatment
for their addiction; they receive primary care or medical treatment,
they can get counselling, they can get mental-health care," Byres said.

He added that many of the same studies have shown participants given
diacetylmorphine also record reduced criminal involvement.

"Diacetylmorphine has proven effective in multiple trials around the
world," he said. "Over time, as patients stabilize, other health
outcomes improve, they have less illegal or illicit

The Conservative government has strongly opposed doctors prescribing
diacetylmorphine in Vancouver. Health Canada did not make a
representative available for an interview by deadline.

Interviewed by the Straight in March 2014, Health Minister Rona
Ambrose maintained her office's positon is grounded in science.

"There are scientists and researchers, clinicians, who have worked in
the area of addictions for decades, who believe that this is a good
decision," she said. "I'm happy to provide you with some their accounts."

In the months that followed, Health Canada did not respond torepeated
requests for those records. Finally, in October 2014, a freedom of
information request revealed the ministry consulted only one
scientific report on the matter; furthermore, the evidence presented
in that document contradicts opinions on diacetylmorphine voiced by

In October 2013, B.C. Health Minister Terry Lake expressed his support
for heroin-assisted treatment.

"We have to think outside of the box sometimes," he said. "I know that
the thought of using heroin as a treatment is scary, but I think we
have to take the emotion out of it and let science inform the
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