Ottawa will consider adopting national guidelines for prescription heroin and other unconventional therapies to treat severe opioid addiction, looking to guidelines being developed by doctors in British Columbia, where such treatments are already available on a small scale.
Federal Health Minister Jane Philpott told The Globe and Mail she is assembling a roundtable of experts that will explore treatment options for opioid dependency, including those studied and piloted in B.C., such as prescription heroin, hydromorphone and slow-release morphine.
It will be the first time Ottawa demonstrates support for the expansion of evidence-based but controversial treatments outside of B.C. It is a departure from the stand of the previous Conservative government, which in 2013 banned doctors from prescribing heroin – a move that the Liberal government overturned last fall.
"I think we need to support the provinces and territories as they, hopefully, look to making these types of treatments more available for severe addiction," Dr. Philpott said. "We're working on having a roundtable where [experts will] talk about whether or not these guidelines could be expanded, or could be made available as federal guidelines."
For people who do not respond to conventional treatments, such as Suboxone and methadone providing pharmaceutical-grade opioids in a medical setting has been shown to result in physical- and mental-health improvements and reduced illegal drug use and criminal activity. Patients are engaged in their health care and are less likely to ingest illicit drugs tainted with fentanyl and its analogues – one of the primary drivers of the overdose crisis sweeping North America.
Evan Wood, medical director for addictions services at Vancouver Coastal Health and interim director of the B.C. Centre on Substance Use, is leading the development of B.C.'s guidelines. His group will explore : What can be done regarding the regulatory challenges of importing pharmaceutical-grade heroin? Who is eligible for these treatments? How can physicians support patients' transition to less intensive and more affordable options?
These treatments are but a few in a wide range needed, Dr. Wood emphasized. "We need more evidence-based approaches across the entire continuum, whether that's circumstances when no medication is required – improving and augmenting recovery-oriented systems of care – and also that small segment of the population where a more intensive intervention involving medication, and for some, involving [heroin], may be appropriate."
Advocacy groups have called for the urgent expansion of treatments such as these, particularly in light of the escalating number of overdose deaths.
"These are fairly complex issues – legislatively, politically, clinically, regulatory – and it does take some time to work through them," Dr. Perry Kendall, B.C.'s provincial health officer, said in an interview. "But we need to do that as quickly as we can."
Heroin-assisted treatment has been available for years in European countries including Switzerland, Germany and Denmark.
Hydromorphone, a licensed pain medication commonly used in palliative and acute care, was shown in a recent Vancouver study to be an effective substitution treatment for opioid dependence and does not have the stigma of heroin.
However, it is not currently licensed for addiction treatment, which makes its use for this purpose off-label. Dr. Kendall said this would likely pose a barrier to getting it into the guidelines for regulatory reasons.
"I think the [College of Physicians and Surgeons of B.C.] would have difficulty recognizing off-label use as a standard use," he said.
No one from the college was available for an interview on Thursday.
On Wednesday, B.C. health officials held a news conference to announce the province's final tally for illicit drug overdose deaths in 2016. In all, 914 people died – nearly double the number in 2015, and B.C.'s worst death toll in three decades of record keeping.
At that news conference, Dr. Kendall called for broader access to opioid substitution treatments, such as heroin-assisted treatment. "These treatments, while very controversial in North America, are proven to work," he said. "Like methadone and Suboxone, they improve physical and mental health and social functioning. They are cost effective and take people out of illegal markets."
B.C. Health Minister Terry Lake agreed with Dr. Kendall.
"I think if you have diabetes and we could cure you, that would be the first option," he said. "But if we have to give you insulin every day to keep you healthy, then that's the second option."