A research group in Vancouver has recommended health-care providers offer injectable medical-grade heroin, or another prescription drug, to severely addicted patients if treatment with oral medication is not effective in decreasing cravings. This is being presented as a solution for those individuals who could die from overdose by street drugs.
The guideline, contained in an article published in the Canadian Medical Association Journal (CMAJ) journal, outlines the optimal strategies for providing injectable opioid treatment with prescription heroin and hydromorphone for individuals with severe opioid use disorder. Moreover, the guideline was created for a wide range of health care providers due to the urgent need to address the high numbers of opioid-related overdoses and deaths in Canada.
In her interview with CTV News, Dr. Nadia Fairbairn, an addiction specialist at St. Paul’s Hospital in Vancouver and the principal investigator of the study, said the published guideline includes the best practices for innovative treatment necessary to address the overdose crisis causing thousands of deaths in Canada. “I think we really are going to need to think about how history’s going to look back on this era where we’re losing so many Canadians to a totally preventable cause like opioid fatalities,” said Dr. Fairbairn.
The study reports that 4,460 Canadians died from opioid overdoses in 2018, and of these, 94% were accidental deaths, which accounts for a 9% increase from 2017 and a 48% increase since 2016. The guideline included in the publication is aimed to support health care providers to deliver life-saving prescription treatments for opioid addiction in order to prevent overdoses.
“Opioid use disorder is a public health emergency nationwide; unfortunately, resources for the treatment of opioid addiction have been scarce and guidelines outlining best practices for innovative treatments have been lacking. This guideline is a blueprint for health practitioners to step up and provide evidence-based care,”Dr. Fairbairn, addiction specialist at St. Paul’s Hospital, Vancouver
Recommendations outlined in the guideline include the use of the injectable opioids diacetylmorphine or pharmaceutical-grade heroin and hydromorphone in patients who inject illicit opioids and do not respond to oral treatments, which include methadone and buprenorphine.
Currently, the only facility in North America which offers diacetylmorphine and hydromorphone, the treatments recommended in the guideline, is The Crosstown Clinic in Vancouver.
According to the results of a previous study entitled “Study to Assess Longer-term Opioid Medication Effectiveness,” published in 2016 in the Journal of the American Medical Association Psychiatry, injectable hydromorphone and diacetylmorphine are equally effective in treatment of severely addicted heroin users who don’t respond to oral therapy.
Similarly, another study entitled “North American Opiate Mediation Initiative” carried out between 2003 and 2004, found published in 2016 and in 2004, respectively, found diacetylmorphine to be an effective treatment for chronic heroin users when methadone does not work.