Prescription Heroin

Canada has just approved prescription heroin injections for treatment of addiction.  Diacetylmorphine, as pharmaceutical grade heroin is known, will be injected by a nurse at special addiction treatment clinics for free.

The goal is to keep people off the streets, put dealers out of business, and protect people from overdose deaths.  The question is, will it work?

Those who are addicted to heroin will be able to enroll in a clinic treatment plan where they will come in and receive prescription heroin injections using sterile needles by a nurse.  They may need injections 2-3 times daily, which would be difficult for people trying to manage a job and family at the same time.

We have similar programs here in the USA for heroin addicts.  Suboxone and methadone clinics provide long-acting narcotics to prevent cravings and reduce the risk of addicts going back to the streets looking for a high.

In spite of these clinics, heroin abuse and heroin overdose deaths continue to climb.  Current thought is that addicts start with narcotic pills and then, when the supply of pills dries up, they switch to cheap and plentiful heroin to get their fix.  Heroin is now commonly mixed with fentanyl which is much more powerful and may be partly to blame for the recent surge in overdose deaths.

Since we have treatment options that decrease the risk of overdose, why do we have increasing numbers of overdose deaths?  Why do people choose to shoot heroin when they can get pills, prescribed by a doctor and paid for by insurance, that reduce the cravings for narcotics?

That’s a pretty complicated question, but an important one to discuss in trying to predict whether Canada’s approach of providing prescription heroin will be effective.

First of all, it is a fact that there is still a huge stigma in seeking treatment for addiction.  People would rather risk death than admit they cannot stop without help.  This problem will NOT be addressed by Canada’s approach.

Second, it is difficult to get an appointment in the USA in a Suboxone or methadone clinic.  There aren’t enough clinics licensed and trained to administer the drugs to keep up with the number of patients who need treatment.  It is difficult to get certified and, to be honest, few doctors find treating addicts rewarding.  High relapse and recidivism rates combine with the generally difficult nature of treating addicts (they often have mood and personality disorders) and the result is there aren’t enough treatment programs available.  Simply licensing prescription heroin will not solve this problem in Canada, either.

Who will administer the drug?  What doctors are going to be willing to have a drug with such high street value openly available in their clinic?  How will law enforcement protect the clinics from addicts and dealers seeking to steal clean, safe heroin from clinics and pharmacies?

I’m afraid that prescription heroin will fail in Canada, if Canada does not address these two problems (stigma of treatment and lack of availability of treatment programs).

You can have the most effective and safest treatment options possible and, if no one can or will take advantage of them, they will not make a bit of difference.  Every car manufactured on the planet has seat belts built in, and yet there are plenty of people who refuse to wear them.

QUESTION: Do you think providing clean, safe drugs for addicts is a good idea?  Why or why not?

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One thought on “Prescription Heroin

  1. Maybe it will reduce crime, give a more productive life,and maybe slowly reducing the amount used can lead to recovery. No one grows up and says I want to be a heroin addict. Unfortunately it happens. The regulations are only 30 pts per practice to give out Suboxone etc, how will people ever recover at the alarming rates of heroin abusers vs clinicians who treat. Addiction medicine should be a specialty, just like pain management now. Cold turkey is dangerous just as using. But they got to want it.

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