Pubdate: Wed, 13 Apr 2016
Source: Globe and Mail (Canada)
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Peter McKnight
Page: A11
Cited: Pivot Legal Society: http://www.pivotlegal.org/

THE DAMAGE DONE

Outcomes improve when you take the drug off the street and bring it
into a clinical environment

For the last 16 months, with fentanyl ravaging street-drug users
across the country, more than 100 users at Vancouver's Providence
Crosstown Clinic have been quietly injecting prescription heroin.
During that time, not one of the clinic's patients has received heroin
laced with fentanyl. Not one has overdosed. And not one has died.

This is all the more striking when you consider that Crosstown's
patients are among the most vulnerable of drug users. All are
long-term heroin addicts, many have previously overdosed or suffered
other serious complications associated with their drug use, and all
have repeatedly tried and failed to get clean.

Or perhaps it isn't that striking. This is, after all, what happens
when you remove heroin from the street, with all its plagues and
pestilence, and bring it into a medical environment. This is what
happens when patients inject pharmaceutical-grade heroin under a
physician's supervision, while receiving full medical, psychological
and social support. And this is what happens when you treat heroin
addiction as a medical matter instead of a criminal one.

It's happened before. Trials in Denmark, Germany, the Netherlands,
Switzerland and Britain all found heroin-assisted therapy more
effective than methadone for those who previously responded
unsuccessfully to conventional forms of maintenance treatment. And all
of those countries have now officially adopted prescription heroin
programs.

Canada, too, has produced solid evidence in support of heroin-assisted
therapy. The North American Opiate Medication Initiative (NAOMI), the
continent's first clinical trial involving prescription heroin, found
that long-term, treatment-resistant addicts treated with heroin enjoy
improved physical and mental health.

It further discovered that they are more likely to remain in therapy
and less likely to take illegal drugs and commit crimes than those
treated with methadone.

The NAOMI trial was followed by the Study to Assess Longerterm Opioid
Medication Effectiveness (SALOME) which, according to a recent paper,
again demonstrated the effectiveness of heroin-assisted therapy for
hard-to-treat patients. And it further found that injectable
hydromorphone (the opioid painkiller Dilaudid) is effective at
treating problematic heroin addiction.

The NAOMI and SALOME trials therefore provide us with strong evidence
for two effective means of addressing hard-to-treat heroin addiction.
And access to both heroin and hydromorphone is essential, since what
works for one patient might not work for another. But access, as it
happens, is the problem. Upon completion of the trials, participants
were left to secure a source of pharmaceutical-grade heroin to
continue their treatment, lest they return to street heroin, with all
its impurities, including fentanyl.

Ordinarily, participants' doctors could receive heroin through Health
Canada's Special Access Program (SAP), which provides access to
otherwise unavailable drugs. But in late 2013, as SALOME was wrapping
up, then-health minister Rona Ambrose introduced amendments to make
heroin ineligible for the Special Access Program. And this meant that
it was back to the street for the most vulnerable drug users.

In response, Providence Health Care, together with Vancouver's Pivot
Legal Society, launched a Charter challenge to ensure patients'
continued access to heroin. And in May, 2014, the B.C. Supreme Court
granted an injunction permitting SALOME participants to access heroin
through SAP. So the former SALOME participants, who are now the
patients at Crosstown, continue to flourish. Yet the vast majority of
opioid users remain on the outside looking in, playing a game of
Russian roulette with every needle they inject.

It need not be this way. The current federal government has done much
to undo the damage occasioned by the previous government, especially
with respect to drug policy. And it can continue that honourable work
by ensuring that heroin is once again available under the SAP program,
so that everyone who needs this life-saving medication receives it.

Now, that said, it's important to emphasize that not every opioid user
needs prescription heroin. Yet if we commit to bringing heroin, and
heroin users, off the street and into the clinic, then no user need
ever again worry if the needle in their arm contains a lethal dose of
fentanyl, or if this latest fix will be their last.

Peter McKnight is an adjunct professor in the School of Criminology at 
Simon Fraser University.
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MAP posted-by: Matt