North America's First Heroin Prescription Program Introduced in Canada
By Am Johal
Vancouver - 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 Drug and Substances Act, came a year
and a half after Vancouver had opened North America's first safe injection site.
Dr. David Marsh, a UBC Clinical Associate Professor, in the Department of Healthcare and Epidemiology, says, "Each
research subject will be on either heroin or another approved treatment substitute such as methadone." According to him,
Switzerland and 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.
Some addicts in the community have criticized parts of the study in the locally based Vancouver Sun which require
participants to give urine samples, reveal their medical history and a criminal record 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 location is in Vancouver's downtown eastside neighbourhood, in the downtown peninsula, not far from where the
Olympic Games will take place in 2010. It is located 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.
The intake of participants for the study will happen over the next year and each participant will be 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 with a documented case history of 5 years of heroin dependence, daily use for a
year, 25 years of age and older, have tried methadone more than once and people who live within a mile of the study
site. This project is funded through the Canadian Institute of Health Research Studies and supported by the BC Ministry
of Health and Health Canada.
Jim Boothroyd, Communications Director for the BC 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 in Montreal and the Center for Addiction and Mental
Health which is affilliated with the University of Toronto."
There has been criticism of the expansion of health services in the downtown eastside neighbourhood by business groups
and some resident associations who feel that the expansion has only exacerbated the problems. Provincial cuts including
placing limits on the length of time an individual can collect social assistance has increased homelessness in the
neighhbourhood where drugs are readily available.
Since 1990, over 2,000 overdose deaths happened in British Columbia and by 1997, Health Canada had declared a public
health emergency in the Downtown Eastside neighbourhood where HIV/AID rates were reaching 25% of drug users and TB and
Hepititus C rates were abnormally high. This led to numerous planning and zoning turf wars that pitted competing
neighbourhood interests against one another.
The former coroner, who had dealt with many of the overdose deaths was elected mayor in 2002. Mayor Larry 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 should not have taken so long to get started. He says he
knows the first person who joined the study and he's already noticed the difference in a the person he's known for over
25 years. "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 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 changes that are necessary.
"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, " says Kim Kerr, Executive Director of
the Downtown Eastside Residents Association. "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."
ENDS