The Stream

Prescription heroin

Unconventional treatment for Canada’s opioid crisis.

Growing evidence shows that heroin addicts may be best helped with prescription doses of more heroin. After successful trials in one Canadian clinic, the federal government is now mulling how to expand the model.

It may seem illogical, but drug programmes based on heroin maintenance have done well in several European countries. Some Canadians are skeptical, but as the opioid crisis grows, many are looking to the success of the prescription heroin programme at Providence Health Care’s Crosstown Clinic in Vancouver.

The plan began as a clinical trial in 2005, funded by the British Columbia provincial government. The province had long permitted needle exchanges and monitored injection spaces, a policy that saw an overall reduction in overdoses near those facilities. At the Crosstown Clinic, addicts come in several times a day to inject “clean” drugs free of fentanyl, a substance found in street heroin and largely responsible for the upswing in overdose deaths. British Columbia alone had 914 deaths in 2016.

Today, 130 patients at the Crosstown Clinic are on injectable opioids, about 100 are on medical heroin and the rest are on the legal painkiller hydromorphone. They are all chronic addicts. The average time they have been on opioids is 15 years, and other treatment methods have not worked for them. The clinic is monitored by medical personnel, and users can seek help for illness and nutrition issues.

It found their programme has brought down costs to the criminal justice system, reduced addicts’ criminal activity and helped patients get healthier.

We take a look at the controversial heroin maintenance programme and how it impacts users, and the communities they live in.

In this episode of The Stream, we speak with:

Dr. Scott MacDonald @_DrScott_
Physician Lead, Providence Crosstown Clinic

Lisa James
Crosstown Clinic patient

Dr. Gabor Mate
Addiction specialist 

Marshall Smith @votemarshall
Chair, British Columbia Recovery Council

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