Prescribe heroin to addicts who can't kick habit using detox, methadone: UBC doctor

Richard Chenery rests after injecting heroin he bought on the street at the Insite safe injection clinic in Vancouver, B.C., on Wednesday May 11, 2011. (THE CANADIAN PRESS/Darryl Dyck)

TORONTO -- An addictions expert at the University of British Columbia is renewing the argument for prescribing heroin to addicts who have tried and failed to kick their habits.

Dr. Martin Schechter says there is a small subset of heroin addicts who have tried to quit but cannot succeed using traditional methods such as detox programs or methadone treatment.

Schechter says giving these people access to heroin in treatment, rather than leaving them to find it on the street, is better for them and for society in general.

He says if they remain untreated they may end up contracting HIV or other diseases from sharing needles.

They are often in and out of hospital emergency rooms and sometimes have to resort to sex work or criminal activity to raise money for drugs.

Schechter says six randomized controlled trials in Europe and Canada have shown that heroin-assisted treatment is more effective for this group of addicts than conventional therapies.

But he says political opposition to the idea of giving addicts drugs prevents doctors from treating people in this manner.

"The real problem is not that we don't know what to do, because the science is very clear about the benefits for this particular sub-population (of addicts). The problem is political," says Schechter, a professor in UBC's school of population and public health.

Schechter's commentary is published in the medical journal BMJ, which asked him to write an article addressing the issue.

Schechter was the principal investigator of a trial conducted in British Columbia, which randomly assigned persistent addicts to receive either prescribed heroin or standard treatment. That trial, known as the NAOMI trial, found those on prescribed heroin used fewer illicit drugs and were involved in less criminal activity.

He explains the rationale behind this approach to care.

"Ultimately what we would like is for people to get stabilized and eventually move on to try therapies. The point is that when they're in full-blown street heroin use and completely out of touch with the health-care system, their chance of improving their lives is zero," Schechter says.

"What this recognizes is that if you can get them out of that cycle of crime and illness and get them stabilized where they don't have to do sex work and breaking and entering … and get them in touch three times a day at a clinic with doctors, nurses and counsellors, you stabilize their lives."

Benedikt Fischer, a senior scientist at Toronto's Centre for Addiction and Mental Health, has argued for years that it makes sense to prescribe heroin to addicts who cannot quit.

He says at this point, heroin addicts make up a small fraction of the population of people addicted to opioid drugs in Canada; most are addicted to prescription drugs like Oxycontin and fentanyl.

"The number of people for whom we would consider this clinically in Canada is actually realistically quite small," says Fischer.

"But again, because the opposition is political, even if there was only one or two people for whom this would be warranted, I think the decision under the (current) political realities would still be 'No.' And that's where the problem is."

The federal government has opposed a number of so-called harm-reduction programs, such as Vancouver's safe injection facility, Insite.

The question may eventually end up being answered by the courts. Some former participants in a followup to the NAOMI trial have appealed to the B.C. Supreme Court to be allowed continued access to prescription heroin, but a decision is not expected soon.