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 plan, released on Monday before it goes to a Board of Health meeting next week, says Toronto Public Health should "explore the feasibility" of allowing doctors at its main downtown harm-reduction clinic to prescribe pharmaceutical-grade heroin to certain opioid users. Health Canada moved last year to allow the practice for people suffering from severe opioid addictions after other treatments had failed.
The calls comes less than a month after Toronto Police issued a warning that street heroin was being laced with fentanyl, which can be 50 times as potent, and blamed the mixture for the overdose death of a 28-year-old Toronto man.
The action plan also calls for new training on how to prevent and respond to overdoses for frontline city staff, such as Toronto Community Housing workers and Toronto Transit Commission drivers. It asks for new funding to distribute naloxone, an anti-overdose drug, and to hire a full-time epidemiologist to run a real-time monitoring program of overdose data.
The plan also says health officials will continue with the development of "drug-checking" programs, as have been implemented in B.C. at music festivals, that see harm-reduction workers test drugs on-site to determine what they actually contain and prevent overdoses.
Downtown City Councillor Joe Cressy, chairman of Toronto's drug strategy implementation panel, said the action plan is needed to deal with the emerging crisis, which has seen overdose deaths increase dramatically as new more potent drugs such as fentanyl has appeared on the streets.
He said public attitudes are changing on once-controversial harm-reduction measures, noting the city is already building three new small-scale supervised drug injection sites where drug users can inject drugs under the watchful eyes of a nurse who can intervene in the event of an overdose.
"It is fundamentally about treating drug use as public health issues, not a criminal justice one, because we know the impacts are better," Mr. Cressy said.
The entire action plan comes with a $370,000 price tag, with all but $94,000 supposed to come from the province. For the funding to flow before next year's budget, reserve funds or surpluses would have to be redirected.
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 was overturning 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.
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, which would be free, are less likely to overdose as a result, and are more likely to hang onto jobs and housing, they say, surviving long enough to have a hope of one day moving off drugs.
Under the City's proposal, the drug would be available as part of a treatment program offered at the Works, Toronto Public Health's downtown harm-reduction clinic near Yonge-Dundas Square.
But the action plan also says Toronto Public Health should work with the rest of 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."
Mr. Cressy said that under the city's plan, doctors could to apply to the federal program for each patient they believe needs prescription heroin. He did not know how many patients would be eligible. This part of the plan, he said, does not require city council approval and can go ahead immediately under federal rules.
The Works is one of three clinics in the city that are preparing to open new supervised injection sites. 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 such as Vancouver's well-known Insite facility. Others are planned for Victoria and Montreal as well, after the federal government announced it was loosening restrictions imposed on them by the previous government.
Provincial funding for Toronto's three new clinics was pledged 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.
Mayor John Tory said his priority was to save lives but acknowledged the concept of prescribing heroin could be controversial. While he did not commit to increasing funding for the overdose plan, he said he would be interested in reviewing anything that could help prevent overdose deaths.
"They're embarked on some consultations now about some things that may have a degree of controversy associated with them," Mr. Tory said. "But I am very anxious to hear the advice they can offer us with respect to how we can save lives. And if there are measures that could do that, and that are responsible, and that are representative of best practices then I am certainly interested in hearing more about them."