Canada gives up on addicts with approval of prescription heroin
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Canada has thrown in the towel in the fight against the heroin epidemic by legalizing heroin. Proponents of this approach point to research showing increased stability in the lives of individuals addicted to heroin and reduced costs to society.

This new policy is a setback to fighting the raging heroin epidemic in North America as it sends out the signal that is somehow okay to be doing heroin, gives them no hope of recovery, and takes away the incentive to try to get off of drugs — sentencing these patients to a life of addiction to a deadly drug. This policy move is sure to accelerate the experimentation with and addiction to opiates in Canada.

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The way the program would work in Canada is that doctors apply for a waiver to prescribe prescription grade heroin, and individuals addicted to heroin go to special treatment centers to inject the drug under supervised conditions for free. This is known as “heroin maintenance.”

To give the program its due, it is intended only for a small minority of individuals who have repeatedly failed traditional treatment. There is also research showing the lives of such individuals are more stable with better access to housing and reduced participation in criminal activities. The cost of such treatment is estimated to be lower than the costs of providing substance use related health care (lesser overdoses, lesser infections) and criminal justice costs.

However, it is important to consider the practical limitations of the policy:

Who is considered to be “not treatable” using traditional treatment? Who determines that an individual addicted to heroin is “eligible” for this program? An individual with a heroin addiction not yet considered as “not treatable” has to scour the streets to buy illegal heroin of questionable quality. I am left to wonder whether he or she will be incentivized to seek the “not treatable” label and obtain high quality heroin for free rather than seek traditional treatment and enter recovery.

Oftentimes heroin users mix multiple drugs (opiates + benzodiazepines or opiates + alcohol) to obtain their desired high. What will be next once we have opened this door of heroin prescriptions. Will other drugs and alcohol also be provided free of cost at these centers or will the individual have to “walk” the streets to find them. Mixing opiates with alcohol or benzodiazepines is not recommended, I am concerned because patients need to be drug tested to ensure they are only taking the prescribed heroin.

While proponents of “heroin maintenance” approach focus on relative stability in the lives of individuals addicted to heroin, they ignore the quality of life they will be leading with this program. Despite the availability of treatment options, these individuals will likely remain addicted to heroin and will be getting high on heroin every day. It is unlikely that they will become productive members of society.

In my opinion, the policy will likely sway a large number of ambivalent individuals addicted to heroin to try and get into the legal prescription program rather than take the much harder path to recovery. It will also incentivize greater experimentation with heroin by new users as the “safety” feature built in, may allow them to worry less about the consequences of addiction.

While politicians can claim they have taken a significant step to fight addiction, in reality, it constitutes a setback to the fight against addiction as legalization brings heroin into the mainstream (much like marijuana). Consequently, I fear a further escalation in heroin use in North America if “heroin maintenance” treatment is widely implemented.

Indra Cidambi, M.D., Medical Director, Center for Network Therapy, is recognized as a leading expert and pioneer in the field of Addiction Medicine. Under her leadership the Center for Network Therapy started New Jersey’s first state licensed Ambulatory (Outpatient) Detoxification program for all substances nearly three years ago. Dr. Cidambi is Board Certified in General Psychiatry and double Board Certified in Addiction Medicine (ABAM, ABPN). She is fluent in five languages, including Russian.


The views expressed by contributors are their own and not the views of The Hill.