VICTORIA—Prescribing medicinal heroin to prevent overdose deaths might appear to clash with common sense, but the provincial health officer in B.C. is backing the idea because he says European-style drug treatment programs work.
The arrival of the powerful opioid fentanyl drove B.C.'s death toll to a new peak last year of 914 overdose deaths—almost 80 percent higher than the 510 deaths recorded by the provincial coroner in 2015.
Dr. Perry Kendall said he wants support from colleagues in health care and law enforcement to push the province to create treatment programs that prescribe a pharmaceutical-grade version of heroin, called diacetylmorphine.
“It may be counterintuitive for people but they have been shown to improve functioning, improve physical health, improve mental health,” noted Kendall.
“They certainly get people out of illegal drug markets and many of those people have gone on to have relatively stable lives.”
Treatment studies from Europe, where medicinal heroin started being widely prescribed in the early 1990s, show declines of illicit drug overdose deaths and disease rates linked to intravenous drug use, including HIV, Kendall said.
Vancouver's Crosstown Clinic in the Downtown Eastside is the only clinic in North America that provides supervised medicinal heroin.
Dr. Michael Krausz, the University of British Columbia's Providence health-care leadership chair of addiction research, said people are dying while next steps are debated rather than using the successful blueprint from Europe.
“I'm frustrated that things are so obvious and we are waiting another month and another month,” he noted.
“Every day we are losing more young people.”
Krausz helped start drug treatment projects in Europe, and much of his work was done in Switzerland when it was gripped by a heroin overdose crisis similar to B.C.'s.
Krausz said Switzerland, followed by Germany, the Netherlands, Denmark, and other European countries, started drug treatment programs that included prescribed heroin, heroin substitutes, and immediate detox and counselling services.
Drug overdose deaths declined and lives were changed and saved, he noted.
“What you see is there is no overdose crisis in Zurich," said Krausz. ”There is no overdose crisis in Basil and there is no overdose crisis in Berlin or Hamburg.
“The numbers did decline over the last decade, where in some cities they are not even collecting or publishing numbers.”
B.C. Health minister Terry Lake said the province is leading North America when it comes to drug treatment policies, including safe injection sites and the prescribed heroin trial at the Crosstown Clinic.
The province also has expanded availability of the heroin substitutes suboxone and methadone.
B.C.'s Centre on Substance Use, meanwhile, is developing new guidelines for drug treatment and prescribed heroin is part of that review, but more work needs to be done, Lake said.
“People tell me, 'Yes, you should just do it,' but you have to be careful of any potential unintended consequences,” he stressed.
“Just because it's done somewhere else isn't a reason to do it here.”
Lake said if he gets evidence to support the plan, he will follow through.
“We are doing more than any other North American jurisdiction,” he reiterated.
“That's not a reason to rest on our laurels or progress even further, but we need the evidence first,” Lake said.
“That work is ongoing.”