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Toronto health officials recommend prescribing heroin to opioid addicts

Those receiving prescription heroin experienced better physical and mental-health improvements than those on methadone, the most common heroin replacement drug. (Jacob Hamblin/Getty Images/iStockphoto)

In a new action plan meant to stem the growing tide of drug-overdose deaths, Toronto Public Health officials are recommending that Canada’s largest city offer some drug users prescription heroin to help them manage their addictions.

The proposal, released on Monday before it goes to a Board of Health meeting next week, would take advantage of changes Health Canada made last year to allow doctors to prescribe pharmaceutical-grade heroin to people suffering from severe opioid addictions after other treatments had failed.

The idea of supervised heroin therapy is not new, and has been used for years in Switzerland, Germany and the Netherlands.

The Liberal federal government in Ottawa announced last May that it would overturn a ban imposed by the previous Conservative government on the concept, saying that a “significant body of evidence” supports its use to treat a small number of people suffering from severe addictions. It followed through in September.

Doctors in Vancouver drew attention to the issue of prescription heroin three years ago after clinical trials found that, for a few entrenched addicts who had failed repeatedly with more traditional treatments, prescription heroin administered in a supervised, medical setting was safe and effective.

Those receiving prescription heroin experienced better physical and mental-health improvements than those on methadone, the most common heroin replacement drug. They were also more likely to stay in treatment and less likely to engage in criminal activity, according to the results.

Proponents of the concept also point out that prescribed heroin is safer than street drugs, which officials warn are increasingly laced with fentanyl and other more powerful opioids ‎blamed for a rising wave of overdose deaths. Those using prescribed heroin would be less likely to overdose as a result.

Just last month, police issued a warning after street heroin was found laced with fentanyl, which can be 50 times as potent, and blamed for the overdose death of a 28-year-old Toronto man. Under the City’s proposal, the drug would only be available as part of a treatment program offered at the Works, Toronto Public Health’s downtown harm-reduction clinic near Yonge-Dundas Square.

The Works is one of three clinics in the city that are preparing to open new supervised injection sites, where drug users, after obtaining their own drugs, would be able to inject under the observation of a nurse, who could intervene in the event of an overdose. The Works and the other two sites already distribute clean needles to drug users under the city’s harm-reduction program aimed at lowering the risk of HIV and other diseases from the sharing of used needles.

Ending years of opposition from the previous Conservatives, the federal Liberal government has said it supports new supervised injection sites, which are now being planned for Victoria and Montreal as well, and last year it announced it was loosening restrictions imposed on opening them by the previous government.

Provincial funding for Toronto’s three new clinics was announced last year, after city public health officials held public consultations and won approvals for the sites from Police Chief Mark Saunders, Mayor John Tory and City Council.

The report, released Monday, calls for a wide range of actions that would better track the drug crisis and increase access to anti-overdose treatment and training for nurses and other frontline personnel.

It also calls for public health officials to work with the health-care system to expand “on-demand opioid substitution treatment options” such as “injectable diacetylmorphine (prescription heroin) and/or hydromorphone, according to best practice, at appropriate health settings.”

The plan also says Toronto Public Health officials will: “explore the feasibility of providing injectable diacetylmorphine (prescription heroin) and/or hydromorphone as opioid substitution treatment options through the Methadone Works program, and according to federal requirements.”

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