Canadian Prime Minister Justin Trudeau's government has taken a less draconian approach to fighting heroin
addiction than the previous government did. (Chris Roussakis/AFP via Getty Images)
OTTAWA — The Canadian government has quietly approved new drug regulations that will
permit doctors to prescribe pharmaceutical-grade heroin to treat severe addicts who have not
responded to more conventional approaches.
The move means that Crosstown, a trail-blazing clinic in Vancouver, will be able to expand its
special heroin-maintenance program, in which addicts come in as many as three times a day
and receive prescribed injections of legally obtained heroin from a nurse free. The program is
the only one of its kind in Canada and the United States but is similar to the approach taken
in eight European countries.
he move by Prime Minister Justin Trudeau's government last week is another step in reversing the policies of the
previous government, run by Conservatives, and taking a less draconian approach to the fight against addiction and
drug abuse.
In April, the Trudeau government announced plans to legalize the sale of marijuana by next year, and it has
appointed a task force to determine how marijuana will be regulated, sold and taxed. The government has also
granted a four-year extension to the operation of Insite, a supervised injection site in Vancouver where
addicts can shoot up street-obtained drugs in a controlled environment. The previous government had tried in vain
for years to shut down that clinic.
The latest decision means that any physician in Canada can now apply to Health Canada for access to
diacetylmorphine, as pharmaceutical-grade heroin is known, under a special-access program. The government says
that this kind of treatment will be available for only a small minority of users “in cases where traditional options
have been tried and proven ineffective” and that it is important to give health-care providers a variety of tools to face
the opioid-overdose crisis.
Scott MacDonald, the lead physician at the Crosstown Clinic, welcomed the federal government’s decision. The
clinic, which is funded by the British Columbia provincial government, opened in 2005 to conduct a clinical trial of
prescription heroin and has operated ever since. It provides diacetylmorphine to 52 addicts under a special
court-ordered exemption but expects that number to double over the next year if supplies can be obtained.
The court order came after a constitutional challenge of a 2013 effort by the previous government to stop distribution
of the drug.
Colin Carrie, a Conservative member of Parliament and the party's spokesman on health policy, said his party
remains adamantly opposed to the use of prescription heroin as a treatment option for addicts. "Our policy is to take
heroin out of the hands of addicts and not put it in their arms."
MacDonald says his patients are usually long-term users — one has been on heroin for 50 years — for whom
standard treatments such as methadone and detox have failed after repeated attempts. “Our goal is to get
people into care,” he said. (The clinic also treats another group of addicts with hydromorphone, a powerful
painkiller.)
The demands of the program are high. Patients must come into the clinic two or three times a day for injections,
which is disruptive for those who wish to work or take care of their families. Still, the dropout rate is relatively low.
The patients are healthier, and participation in the program drastically reduces their participation in criminal
activities, sharply cutting the cost to the criminal justice system.
Crosstown’s approach has garnered increasing attention in the United States, with MacDonald appearing in
June to testify before a Senate committee on Capitol Hill. But the approach remains controversial. After making a
presentation recently in Boston, he got a positive response from some doctors but noted that “there were physicians
who would not even come up and talk to me.”
Canadian Prime Minister Justin Trudeau's government has taken a less draconian approach to fighting heroin
addiction than the previous government did. (Chris Roussakis/AFP via Getty Images)
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CEBID - Centro de Estudos em Biodireito
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