British Columbia·Photos

Barriers remain for accessing pharmaceutical-grade heroin

Drug users say the recent federal announcement on methadone and heroin is a step in the right direction, but not good enough.

Warning: This article contains images of drug use that some readers may find disturbing

The drugs are either injected or smoked. (Tina Lovgreen/CBC)

Inside the Vancouver Network of Drug Users' overdose prevention site, Ryan Kingston injects heroin as a volunteer watches through a window to make sure nothing goes wrong. 

Kingston has overdosed here before.

VANDU worker Chereece Keewatin checks on Ryan Kingston as he injects heroin at the opioid prevention centre. ( Tina Lovgreen/CBC)

He has being using heroin for the past year to ease his chronic back pain. He's also on methadone, but said his prescription doesn't numb the pain caused by the three bulging discs in his spine. 

"I'd like to get on something that would work. I just haven't been prescribed anything that does that, so I'm stuck having to use street drugs to accomplish that," he said.

Ryan Kingston reacts after he injects heroin at the VANDU overdose prevention centre. (Tina Lovgreen/CBC)

Kingston, like many other opioid drug users, believes he would be better off if he had access to medical-grade heroin, generally used to treat patients who haven't had success with substitution therapy like suboxone or methadone. 

The Federal Health Minister's announcement on Monday brings them hope that access to medical-grade heroin is a step closer to reality. 

Minister Ginette Petitpas Taylor announced regulatory changes that could see heroin — which can currently only be legally administered in a hospital setting — prescribed and administered by physicians and nurse practitioners at treatment facilities. 

Still heavily regulated

But barriers still remain to accessing medical-grade heroin. 

Jordan Westfall, president of the Canadian Association of People Who Use Drugs, says the changes won't amount to anything unless medical-grade heroin is more widely available in Canada.

"Heroin is still heavily regulated and it needs to be imported into the country," said Westfall. 

Pharmaceutical-grade heroin (diacetylmorphine) is manufactured in Switzerland and can only be imported to Canada in bulk, at times of public-health emergencies.

"It makes it hard to access. What needs to happen is that this drug should be manufactured in Canada," said Westfall.

Kingston holds his arm after injecting heroin to numb his back pain. (Tina Lovgreen/CBC)

In order for it to be manufactured in Canada, a company needs to apply for a Drug Identification Number (DIN), which is a lengthy process involving several government hurdles. 

Currently, the only place offering diacetylmorphine in Vancouver is the Crosstown Clinic in the Downtown Eastside. Only about 100 Canadians have access to it through the single pilot project. There is a wait list of 200.

If they wait much longer there won't be anybody who needs to use it because everyone is going to be dead.- Laura Shaver, president of BCAPOM

The regulatory changes come into effect in May, but whether the supply of diacetylmorphine will change is undetermined. 

That's not good enough for Laura Shaver, president of the British Columbia Association for People on Methadone (BCAPOM) and secretary at the Vancouver Network of Drug Users (VANDU).

"If they wait much longer, there won't be anybody who needs to use it because everyone is going to be dead. There won't be any patients to go on heroin prescription," said Shaver.

Laura Shaver, secretary of the Vancouver Network of Drug Users (VANDU) and President of the B.C. Association for People on Methadone (BCAPOM) said pharmaceutical heroin needs to be available immediately. (Tina Lovgreen/CBC)

Death toll to surpass 4,000

Figures released by Health Canada on Tuesday show that a record number of Canadians died of opioid overdoses in 2017. Fatal overdoses were up more than 45 per cent from the year before.

The government expects the final 2017 death toll will surpass 4,000.

B.C. has been hit particularly hard by the opioid crisis. More than 1,420 people died of illicit drug overdoses in B.C. in 2017. Fentanyl caused more than 80 per cent of suspected deaths last year.

Photos of VANDU members who have fatally overdosed are posted on the makeshift memorial wall above Shaver's desk. (Tina Lovgreen/CBC)

Harm reduction activist and methadone user Garth Mullins argues pharmaceutical-grade heroin needs to be far more widely available, beyond treatment facilities and hospital settings. 

Research has shown prescribed heroin reduces illicit drug use, criminal activity and mortality.

"Someone should be able to go in to any doctor in B.C. and get on prescription heroin, if they are a suitable candidate for that. That's what it means to respond to the overdose crisis. That's what it means to have drug treatment" said Mullins. 

Stacks of needles at Vancouver Network of Drug Users for people to use. (Tina Lovgreen/CBC)