Pubdate: Thu, 04 Aug 2016
Source: Vancouver Sun (CN BC)
Copyright: 2016 Postmedia Network Inc.
Contact:  http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Heather Palis
Page: A11

LIFE-SAVING TREATMENT DENIED TO OPIOID USERS

Studies show these drugs are effective, writes Heather
Palis

One-third of Canadians have a chronic health condition. We all know
someone living with one and count on our universal health care system
to help them.

Thousands of Canadians living with chronic opioid use disorder (i.e.
injecting street opioids daily), however, are often excluded from
universal health care, being denied the treatments they need.

In the first half of the year, British Columbia saw 308 illicit drug
overdose deaths, and is on track to reach 800 preventable deaths by
the end of 2016. Last month, there were 36 overdoses in 48 hours in
Surrey.

B.C. Provincial Health Officer Dr. Perry Kendall has declared a public
health state of emergency and Lisa LaPointe, the province's chief
coroner, has noted that overdoses in the province have taken over as
the leading cause of unnatural death, now killing more people than car
accidents.

While the standard treatments like methadone and Suboxone(R) work for
most people, they don't work for everyone and they don't work all the
time. Approximately 10-15 per cent of opioid users are not helped by
these treatments.

Just as diabetics have varying responses to different types of
insulin, patients with chronic opioid use disorder have varying
responses to different treatment options. As is the standard for other
chronic conditions, a range of evidence-based treatments for the
chronic condition of opioid use disorder should be made available to
those who need them.

Conveniently, strong evidence supporting effective life-saving
alternative treatments already exists and expanding access to these
treatments across Canada is a vital next step.

Pharmaceutical-grade heroin provided in clinics under the supervision
of health-care providers has been proven effective by numerous
clinical trials and has been successfully implemented as part of the
treatment offered in countries across Europe since the 1990s.

In 2008, NAOMI, a clinical trial based in Vancouver and Montreal,
showed this treatment to be safe and effective in the Canadian
context. When untreated, chronic opioid use disorder costs taxpayers
at minimum $45,000 per individual each year in health and criminal
justice costs, while treatment reduces that cost by half.

This year SALOME, a Vancouver-based clinical trial, showed that
hydromorphone (Dilaudid(R)), an already licensed medication used to
treat pain associated with other chronic conditions, could be as
effective as pharmaceutical-grade heroin for the treatment of chronic
opioid use disorder.

Participants of SALOME receive either hydromorphone or
pharmaceutical-grade heroin under the supervision of health-care
providers on a daily basis at Providence Health Care's Crosstown
Clinic in the Downtown Eastside of Vancouver, where in the midst of a
public health crisis not one participant has died of an opioid related
overdose.

In the study there were 88,451 injections administered, with only 14
overdoses, none of which resulted in hospitalizations. Participants in
the trial remain the only ones with access to these life-saving
treatments, from which thousands of Canadians could be benefitting
right now.

The few patients receiving treatment at Crosstown Clinic see
themselves as the lucky ones, and want to see this treatment expanded
to those in need that are at risk of death every day they remain
outside of treatment.

In Canada, pharmaceutical-grade heroin unfortunately is not licensed.
Hydromorphone, however, is licensed and is indicated for the relief of
moderate to severe pain. It is used in health care settings on
hundreds of Canadians every day.

Its use for addiction treatment, however, would be considered
"off-label," meaning it would be used for a condition other that for
that which it is officially indicated. As such, the cost of the
medication is not covered for patients who would use hydromorphone for
the purpose of addiction treatment.

B.C.'s Ministry of Health should conduct a Pharmacare review of
hydromorphone, paying close attention to the evidence and input
available, and take steps to ensure this licensed medication is made
available to all Canadians, regardless of their condition.

After all, the values of our universal Canadian health care system
inform us that anything less would be unacceptable.

Heather Palis is a PhD Candidate at the School of Population and Public 
Health at the University of British Columbia and is a student in UBC's 
Scholars Go Public Institute.
- ---
MAP posted-by: Matt