A B.C. Supreme Court decision allowing staff at a Vancouver addiction clinic to prescribe heroin is producing positive results, and advocates want to see the program expand across the country.
At their regular Saturday morning meeting, a group of heroin addicts runs through an agenda posted on the wall.
January 28 was the group’s five-year anniversary, and there’s a moment of recognition for how people are doing. In recent years, most have transitioned from homelessness to stable housing. Others have found jobs or returned to school. Many have reconnected with family.
Asked about their pasts, everybody has a story of getting ripped off, robbed, or beat up for drugs or a few dollars.
Kevin McGarragan recounted how he lost his arm. He was the passenger in a car being driven to a drug buy when the driver fell asleep. “Car accident in 1993,” he said, looking at where his arm used to be. “Heroin was behind it.”
McGarragan said today, he recalls those stories as if they were from another life.
Quitting heroin is a goal that still eludes him and most members of the group, which calls itself SNAP, or SALOME/NAOMI Association of Patients, named after two clinical trials that ran from 2005 to 2008 and from 2011 to 2015.
What has changed is the way they get their drugs.
In November 2014, McGarragan became one of the first people in North America, outside of a clinical trial, to receive heroin via a doctor’s prescription.
The previous federal government tried to prevent doctors from prescribing heroin as an alternative treatment for opioid addiction outside of clinical trials. It’s only thanks to a May 2014 order granted by a B.C. Supreme Court judge that staff at the Downtown Eastside’s Crosstown Clinic are allowed to administer the drug, also known as diacetylmorphine, to a small group of patients. A legal challenge about whether all doctors should be allowed to prescribe diacetylmorphine as they see fit remains ongoing, with a court date set for October. In the meantime, the court order essentially grandfathers SNAP members into the program at Crosstown.
The clinic’s lead physician, Dr. Scott MacDonald, explained that as participants rotated out of the clinical trials, Crosstown staff noticed them returning to street dealers. Seeking to save patients from harms associated with the illicit drug trade, he said doctors used the federal special access program to continue prescribing them diacetylmorphine at the clinic. That is, until the previous federal government changed regulations to put a stop to that.
Advocates say the program allows addicts to take the first step toward a more normal life, by eliminating the need to constantly find money — through whatever means — for their next fix.
However, the previous Tory federal government did not let the program grow beyond Vancouver, reflecting Ottawa’s position against other harm-reduction programs such as injection sites for drug addicts.
But it’s possible this could change, and that the new Liberal administration might prove more receptive to harm-reduction programs.
At the Saturday meeting, the group’s moderator, Dave Murray, said lawyers representing the five SNAP members who won the court order are still fighting to legitimize prescription heroin. They’re travelling from Vancouver to Ottawa for a meeting with justice ministry staff on Feb. 18.
The lawyers hope to discuss heroin prescriptions for addicts, and other harm-reduction programs, including the expansion of supervised-injection services across Canada.
The Ministry of Justice confirmed the meeting was set to take place, but declined to comment further. Health Canada also refused to grant an interview. An emailed statement expressed support for harm reduction, but continued “it would be premature to speculate on the possibility of changes to the existing legal framework.”
Specifically, the group wants the Liberals to reverse two things passed by the previous government. The first is a 2013 regulatory change approved by then-health minister Rona Ambrose, which removed heroin and other drugs such as cocaine and ecstasy from a list of illicit substances doctors could apply for special access to prescribe. The second is Bill C-2, passed in 2015, which was seen as hindering attempts to open new injection sites in Canada by requiring applicants to talk with police, community members and public health officials before getting an exemption from federal drug laws.
Ambrose’s office declined to grant an interview. Requests sent to Kellie Leitch, Conservative opposition critic for health, were not returned.
McGarragan and other opioid addicts credit prescription heroin for the stability that’s allowed them to turn their lives around.
SNAP member Kevin Thompson first tried heroin in 1995, when he was 22 years old. He described the years since then as an endless cycle. It began by scrounging for money, usually by shoplifting. Then there was a trip to the dealer, finding a place to shoot up, and then waiting for the onset of withdrawal, when the cycle would begin again. Over and over, for two decades.
“My life was chaos,” Thompson said. “No other way to put it.”
There were countless times he tried and failed to get clean, Thompson said. “I used to pawn everything I could to support my habits.”
Today Thompson has a regular job, a steady girlfriend, and has repaired relations with his family.
Jenny Kwan is the NDP MP for Vancouver East, where the Crosstown program operates. She called for the Liberal government to reverse the 2013 regulatory change and for parliament to repeal Bill C-2.
“All of the evidence speaks to the fact that alternative methods need to be tried,” Kwan said. “I think we should follow through based on the science.”
Back at Crosstown Clinic, Dr. Scott MacDonald echoed arguments his patients put forward at the Saturday morning meeting.
“The daily grind of crime, prostitution, and whatever people have to do in order to get their next fix — which can be three to four times a day, in a cycle repeating — is terribly unhealthy,” he said.
Clark described heroin maintenance as a “difficult treatment”, but also as a “lifeline” for addicts that have repeatedly failed with traditional therapies such as methadone.
“We’ve seen some major turnarounds in people’s lives,” he said. “I’ve been very gratified to see people get in contact with their family again, go to school, work, and do computer training. It’s remarkable.”
The case for prescription heroin
Dave Murray is a plaintiff in a legal challenge that seeks to legitimize prescription heroin. In a signed affidavit, he explains the sort of addict for which heroin maintenance could be deemed an appropriate treatment. “I have been injecting heroin and other opioids for approximately 42 years,” it reads. “I estimate that I have attempted methadone maintenance treatment (“MMT”) for my addiction at least 10 times over my life. Each of those times MMT has been ineffective for me and I returned to injecting illicit street heroin.”
Dianne Tobin, a long-time opioids addict, suggested heroin maintenance can be especially beneficial for female addicts. “The women aren’t working the streets anymore,” she said. “I bet you 90 per cent of the women who came into the program were working (as prostitutes) or were dealing … They were mistreated and beaten up and all that by their pimps or whoever. And now they are working in the community instead.”
Scott Harrison, director of urban health for Providence Health Care, explained how the benefits of heroin maintenance can extend beyond its participants; for example, minimizing the spread of communicable diseases associated with illicit drug use. “It doesn’t just improve their overall health but it improves the community’s health,” he said. “People are less involved in crime, and they are not taking street drugs anymore so they are not exposed to a lot of the public health issues that go along with that.”
Prescription heroin — by the numbers
26.6 — Average number of years a clinical trial’s participants spent injecting heroin before they were deemed eligible for enrolment in a heroin-maintenance program.
11.4 — Average number of times a heroin-maintenance patient previously failed to end drug use with a traditional treatment for an opioid addiction such as methadone or abstinence-based therapy.
202 — Number of people legally eligible for heroin maintenance under the terms of the interlocutory injunction granted by a B.C. Supreme Court judge in May 2014.
110 — Number of people receiving diacetylmorphine as part of Crosstown Clinic’s heroin-maintenance program as of January 2016.
500 — Number of City of Vancouver residents it is estimated would be deemed medically eligible for heroin maintenance and receive the treatment if all federal regulatory hurdles restricting access to the program were removed.
$27,000 — Average cost of heroin maintenance for one patient for one year.
$40,000 — Estimated lifetime savings in societal costs for one patient enrolled in a program where heroin-maintenance is an available treatment option compared to a similar patient for which only methadone is available.
87.8 — Rate of retention in treatment for patients enrolled in heroin-maintenance.
Sources: NAOMI study, Providence Health Care, Pivot Legal Society.