Giving people with severe addictions prescription heroin could save lives as Canada continues to struggle with an opioid overdose epidemic, says Health Minister Jane Philpott.
"I know this is a challenging concept for some people to think about, but the reality is that when people go out on the streets they often commit crimes to be able to get the drugs they need. They're buying dirty drugs and they're dying," the physician-turned-politician said in an interview with Chris Hall, host of CBC Radio's The House.
"With people who don't respond to the traditional treatments like the Suboxone or methadone, the people with the most severe addiction, there's actually great evidence that if you give them clean heroin in a medically supervised setting under the direction of a doctor that you can not only help these people deal with their addiction and save their lives, it can lead to a tremendous amount of stability in their lives," said Philpott.
As health minister, Philpott speaks from a bully pulpit, but she's far from the first person to suggest prescription heroin as a potential fix for the fentanyl overdose crisis that killed close to 1,000 people in British Columbia in 2016, and is on track to kill a larger number of people this year.
So far, Providence Health Care's Crosstown Clinic on Vancouver's Downtown Eastside, a neighbourhood particularly ravaged by the opioid crisis, is the only clinic in North America that offers addicts actual heroin.
"I wish her well," said Eugenia Oviedo-Joekes, the lead researcher for the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) conducted at the Crosstown Clinic. Her study showed chronic heroin addiction could be treated with another opiate — hydromorphone — in a controlled setting.
"Do you know how hard it is to know that there is a medication that works but no one seems to just do it?"
Oviedo-Joekes said a huge part of the challenge isn't on the regulatory side; it's convincing the public that fighting addiction with heroin works.
"[It's] very important that a minister of health is saying those words. We need to change the way people see our patients. We are not kind to our patients," she said.
"People need to stop thinking about the drug and start thinking of the people."
Philpott says her government already opened the door to more pharmaceutical heroin when they overturned a ban on prescription heroin in September. New regulations also allow officials to apply to Health Canada for imports of bulk quantities of prescription-grade heroin.
"The provinces will have to request the import. British Columbia, we believe, is very interested in this and then it will require of course the supervision of a physician that would make the prescription," she said.
"It works. It gets people's lives back on track."
Debate over mandatory pharmaceuticals
Conservative Senator Vern White said the Liberal government squandered its chance to make a real change in the fight against drug overdoses when they rejected his amendment to Bill C-37, the new law around supervised consumption sites.
He had introduced an amendment that would have required doctors at these sites to offer substitute pharmaceuticals to drug users as an alternative to using more dangerous street drugs and to discourage the sale of illicit drugs.
Philpott said that would impose too many provisions on addicts who might not be open at first to alternative routes.
"This was their chance because they could have forced these supervised injection sites, the consumption sites, to get into the breach and actually do the right thing," said White, a former Ottawa police chief.
"The reason they're going to legalize marijuana is to get it out of the hands of organized crime, so how about if we provide a drug replacement therapy in supervised consumption sites to get that out of the hands of organized crime."
The Ontario senator says he's looking at the option of introducing a private member's bill to force medical practitioners to offer a pharmaceutical therapy.
"Yeah, we'll save some lives because we have naloxone at those facilities, but we could save a hell of a lot more lives if we didn't have to worry about naloxone and bringing people back to life and instead we knew what we were prescribing."
Physician vs. politician
Philpott, who before entering politics worked as a family doctor, says physicians know how to propose theoretical solutions but politicians have to come up with achievable solutions.
"That's not to say it's not politically challenging and occasionally controversial, but we need to walk people through the steps. We need to say that these people with addiction are not criminals. People with addiction are not failing us morally or making bad choices.
"They have a health problem, they deserve health care and if the way to treat them is to get them access to medications that will save their lives and set them on the path to healing then that's what we need to do."