B.C. mulls framework for expanded heroin-assisted treatment

published on April 7, 2017 by Andrea Woo in The Globe and Mail

Prescription heroin, a last-resort treatment for severe addiction currently restricted to only one clinic in all of North America, could one day be dispensed at pharmacies much as methadone is.

The dispensation model is one of three proposed in a draft of B.C. guidelines for the expansion of supervised injectable opioid-assisted treatment (siOAT) obtained by The Globe and Mail.

The document, being prepared by the nascent BC Centre on Substance Use (BCCSU), is a first-of-its-kind in North America and reflects the centre’s push to provide a wide range of options for people struggling with substance use. Opioid-substitution therapies such as methadone and buprenorphine-naloxone (Suboxone), taken orally, are the most commonly prescribed medications for people with severe opioid addiction, but those who do not respond to these first-line treatments have few other options.

“It has long been recognized that more intensive treatment involving alternative pharmacotherapy options are required, as some patients will not benefit from oral treatment,” the guideline states.

“Research has shown that, among patients who [do not respond] to methadone, prescription diacetylmorphine (heroin) administered in a clinic setting may be beneficial in terms of reducing illegal or non-prescribed opioid use, drop-out, criminal activity, incarceration and mortality.”

The document suggests three models: a dedicated treatment program such as Vancouver’s Crosstown Clinic, where about 120 people currently receive siOAT; a smaller siOAT program integrated within an existing community health clinic; and a pharmacy-based delegated model, where trained pharmacists would dispense and witness injections.

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