North America’s First Heroin Prescription Program Introduced in Canada

The building at the corner of Abott and Hastings in Vancouver, British Columbia, site of North America's first prescription-heroin clinic. (Photo: Don MacKinnon / AFP-Getty Images)

In February, Vancouver became the first city in North America to begin clinical trials for heroin prescription. This step, which required an exemption of Section 56 of the Controlled Drugs and Substances Act, came a year and a half after Vancouver had opened North America’s first safe injection site.

Dr. David Marsh, a clinical associate professor in the Department of Healthcare and Epidemiology at the University of British Columbia, says, “Each research subject will be on either heroin or another approved treatment substitute such as methadone.” According to him, Switzerland and the Netherlands have already approved regular treatment with heroin maintenance as part of the continuum of care after over 20,000 patient years of research. Marsh himself has worked for eight years in Canada to have the North American Opiate Medication Initiative (Naomi) study approved.

Writing in the Vancouver Sun, some addicts in the community have criticized parts of the study, which requires participants to give urine samples and reveal their medical histories and criminal records if they have one. They feel that there are too many barriers to enter the program and that it does not include enough participants.

The site is located in Vancouver’s Downtown Eastside neighborhood, in the downtown peninsula, not far from where the Olympic games will take place in 2010. It is near the existing health-board-managed safe injection site where users bring in their own drugs from the street. The purity of heroin available on the street has been an issue in the past and was deemed to be a contributing factor in many overdose deaths.

Participants for the study will be accepted over the course of the next year and each participant will be a part of the study for one year. Due to the staggered time frame of entry, the study will take over two years to complete and will include Montreal in May and Toronto a few months later.

Initially, the study will take addicts who have a documented case history of 5 years of heroin dependence, have used heroin daily for a year, are 25 years of age and older, have tried methadone more than once, and live within a mile of the study site. This project is funded through the Canadian Institute of Health Research Studies and supported by the British Columbia Ministry of Health and Health Canada.

Jim Boothroyd, Communications Director for the British Columbia Centre for Excellence in HIV/AIDS, says, “Much of the criticism is limited to addiction specialists who question the ethics of the study. This study, however, has been reviewed by the ethical review boards at the University of British Columbia, McGill [University] in Montreal, and the Center for Addiction and Mental Health, which is affiliated with the University of Toronto.”

There has been criticism of the expansion of health services in Downtown Eastside by business groups and some resident associations who feel that it has only exacerbated the community’s problems. Provincial cuts, including placing limits on the length of time an individual can collect social assistance, have increased homelessness in the neighborhood, where drugs are readily available.

Since 1990, there have been more than 2,000 overdose deaths in British Columbia. By 1997, Health Canada had declared a public health emergency in Downtown Eastside, where the HIV/AIDS rate of infection among drug users was 25 percent, and TB and Hepatitis C rates were abnormally high. This led to numerous planning and zoning turf wars that pitted competing neighborhood interests against one another.

The former coroner, Larry Campbell, who had dealt with many of the overdose deaths, was elected mayor in 2002. Mayor Campbell says, “For those who can’t stop taking drugs, this is an attempt to stabilize their life. This program is designed to get to the most chronic users.”

Dean Wilson, the former head of a health board funded drug user group and the subject of a documentary on Vancouver’s drug issues, praises the project: “If we truly believe that addiction is a medical condition, then we need to treat it as such — we need to treat this as a medical issue, not a criminal issue.”

Wilson says the research project is the appropriate action and that it should not have taken so long to get started. Of the first person to join the study, someone Wilson has known for over 25 years, Wilson says that he has already noticed a difference: “He doesn’t have to run around all day figuring out how he’s going to get his next fix — you can see the difference it makes to his self-esteem. I can notice the difference in him after one day.”

Dr. Dan Small of the PHS Community Services Society (formerly known as the Portland Hotel Society) says that the researchers behind the study should be lauded for their courageous attempts to see the study through. Small says, “This is more than establishing a standard of care, it’s about establishing a standard of caring. Illness does not just exist in a clinic or as a subject of study for researchers, but is an on the ground life and death reality for people. The barriers which exist as part of the study are, nonetheless, barriers. For the participants of this study who are suffering, this is not a pilot project, this could be a life saving intervention.”

If the study shows that heroin maintenance does work in treating addiction, Small questions if the relevant agencies will be ready to move forward at the legislative level to make the necessary changes.

Kim Kerr, executive director of the Downtown Eastside Residents Association, says, “We all make bad choices in life, and if the choice is made and someone becomes addicted, then we still have a responsibility to treat addiction as a health issue — it’s a common sense thing. It is a step in the right direction. Methadone around here is a license to print money for the doctors and pharmacies. It’s even being sold on the street.”