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An intravenous drug user gets ready to injects heroin into his arm with a needle in Vancouver's downtown Eastside January 28, 2009.

JOHN LEHMANN/GLOBE AND MAIL

Members of a U.S. Senate committee looking to confront drug abuse struggled with the concept of prescription heroin and raised concerns about supervised-injection sites increasing crime as they heard testimony on Wednesday from a B.C. doctor who helped lead one of the most radical interventions in North America.

Scott MacDonald, physician lead at Providence Health Care's Crosstown Clinic in Vancouver's Downtown Eastside, testified before the U.S. Senate Committee on Homeland Security and Governmental Affairs at a hearing in Washington entitled "America's Insatiable Demand for Drugs: Examining Alternative Approaches." He was one of four experts invited to speak, and the only one from outside the United States.

Dr. MacDonald spoke of clinical trials conducted at the Crosstown Clinic on prescription heroin treatment, which involves giving pharmaceutical-grade heroin to people who are severely addicted to inject in a medical setting under the supervision of doctors. This keeps them from using potentially contaminated street heroin, reduces their risk of blood-borne illnesses, reduces their rate of criminal activities and has them interacting with physicians every day.

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Senator Ron Johnson, chair of the committee, appeared to struggle with the concept, asking what the difference is between the prescription heroin offered at the clinic and "natural heroin," likely referring to street heroin.

"So we have one form of heroin that's produced artificially, that's basically identical to heroin, and that one's legally – because it's medically controlled …" Mr. Johnson said as he attempted to work through the concept.

Like Canada, the United States is in the grip of an opioid crisis fuelled by the abuse of prescription drugs, heroin and the surge of illicit fentanyl on the black market. In 2014, more than 47,000 people died of drug overdoses in the United States, due mostly to opioid pain relievers and heroin, according to the U.S. Centers for Disease Control and Prevention.

Mr. Johnson also asked Dr. MacDonald about the location of the Crosstown Clinic, along with Vancouver's two supervised injection sites. Vancouver's largest and oldest supervised-injection site, Insite, was the first of its kind in North America, and the United States has no similar facilities.

"Your injectable sites: Have they been magnets for drug dealers and crime and that type of thing?" he asked.

"There has been no increase in social instability around the clinics," the physician replied. "They stabilize. There's been no 'honeypot effect,' where people come from other jurisdictions to seek the treatment."

"Was there resistance by the neighbourhoods in terms of establishing those sites?" Johnson inquired.

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"With our first study … yes, there was," Dr. MacDonald said, referring to the Crosstown Clinic. "But having seen the success and the benefits both to the individuals and to the community, I think those have fallen away now."

Senator Rob Portman asked about success rates.

"How many severe heroin addicts were able to return to work or school?" he asked.

Dr. MacDonald said about 5 per cent had returned to work, but that he was hopeful the figure would grow as the two-year-old program continued.

Dr. MacDonald also discussed the off-label use of the pain medication hydromorphone, which a recent Vancouver trial concluded was effective in treating chronic heroin addiction. Because hydromorphone is already legal as a painkiller, it could be easier for some to accept for treatment of heroin addiction than prescription heroin.

The other three speakers were Ethan Nadelmann, executive director of the Drug Policy Alliance; David W. Murray, senior fellow at the Hudson Institute; and Frederick Ryan, chief of police in Arlington, Mass.

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Mr. Murray, who previously was chief scientist and associate director of supply reduction in the White House Office of National Drug Control Policy, said he was not convinced about harm reduction outcomes, including those of heroin-assisted treatment and supervised consumption sites.

"The true task of any good public policy, it seems to me, must meet two criteria: It must be effective – and the case is not made, when you look at the literature, that these things are effective as advertised … – and the second criterion is it must be humane," he said.

"I would say … that for the government to step into the role of officially providing addictive heroin to its citizens so transforms the relationship of the citizen to the government that we should fear it."

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