Health Canada says it has legalized heroin as a treatment option for people with "severe opioid use disorder."
But local advocates in Vancouver say the barriers to accessing clean heroin will still prevent the lion's share of people from getting it. Further, the announcement—or at least the way it was described on social media by Health Canada—isn't new.
On Friday (Feb.18) morning, the federal health department quietly tweeted that it had "approved diacetylmorphine as a new treatment option for adult patients with severe Opioid Use Disorder."
The tweet includes a link to a website that shows that diacetylmorphine (heroin) will be supplied via a company called Pharmascience Inc., which is based out of Montreal.
While the program will be available to drug users who are enrolled in Injectable Opioid Agonist Treatment (IOAT) programs, the drug is only available to people who have "failed" first, according to the verbiage outlined in the product monograph.
In other words, drug users must have failed previous attempts at opioid agonist therapy, including methadone maintenance therapy.
Guy Felicella is a Vancouver-based harm reduction advocate and motivational speaker who battled opioid addiction for decades in the city's Downtown Eastside. For him, the announcement is a step in the right direction because it means Canada doesn't have to import a safe supply of heroin.
But the fact that drug users must have a diagnosed "severe" substance use disorder means that many of the people who need it will not have access to it, he told Vancouver Is Awesome. Further, many of the people who are enrolled in programs drop out because they take up so much of their time, requiring members to return three times daily.
"There are so many barriers," Felicella remarked. "It's almost like if you have an addiction and you're accessing a service like that with a substance use disorder, basically what they do is they just create this other addiction where you have to basically give your life up to that.
"We all often would assume that drug users have no lives outside of using drugs. So we're not going to give them any lives outside of using drugs and we're going to make [them] come [to clinics] every day.
"I mean, I had access to those programs for years and I just said this is just too much...forget it."
Felicella added that the announcement, or the way it was presented by Health Canada on Twitter, isn't new. Heroin is already legally administered to drug users at two clinics in the Lower Mainland: one in Vancouver and one in Surrey. But these clinics service a very small percentage of people who use drugs and only so many spots are available.
Instead, the announcement is that Canada now has a domestic manufacturer of diacetylmorphine and doesn't have to rely on imports from places such as Switzerland. This means the number of people who can access heroin legally can dramatically increase. Several questions remain, however, including who can prescribe the heroin and what changes will be made to accessing it—if any.
A"widely expected" announcement
Dr. Martin Schechter is a Canadian epidemiologist who demonstrated the effectiveness of diacetylmorphine and hydromorphone for the treatment of opioid dependence. He, along with B.C.'s first provincial health officer, Dr. Perry Kendall, lead Fair Price Pharma (FPP): a Canadian non-profit pharma company that has been fighting for a safe supply of clean heroin for years.
While Schechter says Health Canada's announcement was "widely expected," he told V.I.A. that it won't make enough of a difference because the B.C. Ministry of Health told him that it does not intend to "significantly expand the use of this injectable DAM from PharmaScience beyond the few hundred people already receiving it as a result of a BC Supreme Court decision."
Additionally, the epidemiologist said it doesn't address a "dramatic shift" that has occurred in recent years where the majority of opioid users are inhaling their drugs, which is something FPP is focusing on in its formulations.
Data released last week by the BC Coroners Service shows the highest percentage of overdose deaths in the province from 2017 to 2020 was the result of smoking rather than injecting drugs.
Eris Nyx, a co-founder of the Drug User Liberation Front, told V.I.A. that Health Canada's announcement will allow wider access to heroin in Canada but that there are two issues to consider: "One is an ethics question around the manufacture of drugs and the other is an ethics question around access," she explained, noting that the announcement grapples with the first issue but leaves the latter largely unaddressed.
"I don't think the announcement does anything for 99 per cent of drug users," stated the frustrated advocate, echoing conerns only people with severe substance use disorders who meet very strict qualifications will have access to the drug.
"Nobody can access it...it doesn't matter if it's manufactured here or not."
Overdose deaths in B.C. increased by over 25 per cent from 2020, with 1765 deaths in 2020 and 2224 overdose deaths in 2021.
Health Canada told V.I.A. Friday it will have to "decline an interview" for now but will provide a "written response" next week.
V.I.A. also reached out to PharmaScience for comment.
With a file from Mike Howell.