In September 2016 a number of social media posts left readers with the impression that Canada had quietly legalized the general use of heroin, a seemingly shocking claim given the substance’s reputation as one of the hardest and most lethal street drugs.
There was some truth behind the rumor, but the refrain that “Canada legalized heroin” was not quite accurate. According to the Canadian Press, on 8 September 2016 Canada enacted regulatory changes that enable doctors to prescribe heroin to patients who are severely addicted to opioids “in cases where traditional treatment has failed”:
Health Canada has amended regulations allowing doctors to prescribe heroin to people who are severely addicted to opioids.
The government says the country is facing an opioid overdose crisis and healthcare providers need help in treating patients suffering from chronic dependency.
The change to the former Conservative government’s legislation means pharmaceutical-grade heroin can be prescribed under a special-access program in cases where traditional treatment has failed.
However, Health Canada says that while there is scientific evidence to support emergency access to the drug, the treatment is not an option for most people.
Supervised heroin therapy is used in several countries, including Switzerland, Germany and the Netherlands, and a clinical trial in Canada has concluded injectable heroin was more effective than standard methadone treatment.
The decision was made in part due to a growing number of opiate-related fatalities in Canada, including more than 250 deaths in a four-month period in early 2016. The regulatory changes were proposed in May 2016 and described as suitable for “a small group of addicts.”
The American ABC News outlet provided additional detail about the program’s intricacies, including commentary from medical and drug policy experts who underscored that the program was reserved for those suffering from treatment-resistant opioid addiction:
Canada’s health ministry announced that doctors will now be able to prescribe diacetylmorphine or prescription-grade heroin for the treatment of “chronic relapsing opioid dependence.” The drugs will be given through Canada’s Special Access Programme (SAP) which provides access to drugs not currently available on the market for the treatment patients with serious or life-threatening conditions when “conventional therapies have failed, are unsuitable, or unavailable.”
“Scientific evidence supports the medical use of diacetylmorphine for the treatment of chronic relapsing opioid dependence in certain individual cases,” Canadian health officials said. “Health Canada recognizes the importance of providing physicians with the power to make evidence-based treatment proposals in these exceptional cases.”
Dr. Scott MacDonald developed a pilot program that studied the effects of providing prescription heroin to certain users in Vancouver and said researchers have seen huge success with the program.
“This is a kind of last resort to get them into care to get them off the streets,” MacDonald said. “We see them come to us every day rather than stay on the streets… that engagement and retention in care is a significant benefit.”
In the pilot program users must be a long time heroin user, who has tried at least twice to stop using drugs. The drug users are allowed to come to the clinic between two to three times a day where they are provided a syringe and drugs for injection. Medical staff on site monitor the drug users and can intervene if they show signs of overdose.
Daniel Raymond, policy director for Harm Reduction New York, said that providing prescription heroin could viewed as an extension of medicine-based rehab programs that utilize drugs like morphine or buprenorphine that help medically address symptoms of opioid addiction and withdrawal.
“I think the idea is not so much the Marie Antoniette style let them have heroin,” said Raymond. “We know people who struggle with opioid disorder. We’ve been using bufneoprohine, morphine…none of them have been sufficiently scaled up.”
Raymond pointed out this treatment is only right for a small group of drug users.
The recent movement towards marijuana decriminalization (including provisions for recreational as well as medical use) in the U.S. led many social media users to infer Canada’s purported legalization of heroin resembled the dispensary model with which many Americans are familiar. But the Canadian program is akin to neither legal medical or recreational marijuana use in states such as California or Colorado.
Experts have noted that the pool of eligible opiate-dependent Canadians is small, and the new regulations do not allow anyone to walk into a shop and purchase heroin either with a prescription or at their leisure. The program is described as suitable only for long term heroin users who have already attempted traditional heroin cessation treatments at least twice and failed; it does not facilitate heroin acquisition for casual users or others without a documented history of failed addiction rehabilitation attempts.