A public suggestion by the provincial coroner to provide heroin to addicts is turning some heads.
The comments by chief coroner Lisa Lapointe last week came after it was learned 116 people in this province died of overdoses from illicit drugs in January.
It’s widely believed the deaths are a result of fentanyl, a drug 100 times stronger than morphine.
Lapointe said the people who have died haven’t been successful in a variety of treatment programs.
“For these people, I think we would be wise to seriously consider the carefully considered suggestion made by provincial health officer Dr. Perry Kendall – the possibility of providing clean, medical-grade heroin to that small subset of users for whom nothing else has worked,” Lapointe said.
Lapointe told Black Press Tuesday the fine details of delivery and assessment would be largely up to the medical community, but it would be administered to patients in a clinical setting.
Dr. Scott MacDonald at Crosstown Clinic in Vancouver has been administering heroin since the middle of last year.
“He’s managing about 130 patients,” Lapointe said, adding he’s doing it quite successfully.
Prior to last year, there had been a ban on the use of pharmaceutical heroin, but the federal government overturned that law.
Lapointe said use of medically prescribed heroin would be very selective.
“For those who have been dependent for a lengthy period of time, and all other treatment options have been tried and haven’t worked, this is an avenue to treat them,” Lapointe said.
Dr. Ray Baker, a member of the National Recovery Advisory Council and a South Surrey resident, isn’t averse to the idea of using pharmaceutical heroin for some patients.
“Is there a place of heroin-assisted treatment? Yes,” Baker said in an interview from Ottawa. “It’s a tiny place, but we should be doing a lot of other things concurrently or first.”
There aren’t enough resources aimed at recovery-based care, he said.
“To maintain people on an opiate when they’re not properly selected is a tragedy,” said Baker, a leading expert in addictions in B.C.
While he supports the efforts to save opiate users, he suggests that people dying from alcohol abuse is much higher.
Lapointe doesn’t disagree with that, but couldn’t give an exact figure of alcohol deaths, as the cause is usually something else that contributes to fatalities, such as liver failure.
She said alcohol problems have to be tackled through education and prevention.
Baker said there’s a place for harm reduction in B.C., but he said it’s time to get the other three pillars of effective recovery – prevention, treatment and enforcement – securely in place.
He equates harm reduction to palliative care for cancer patients.
“People say to me, ‘Dr. Baker, do you believe in palliative care for cancer?’ “ Baker said. “Should everyone be put on palliative care? I say hell no. I say let’s treat the heck out of it. And those that can’t get well, we’ll put them on palliative care. But let’s hope that’s a tiny number once we’ve got the treatment in place.”
Surrey Mayor Linda Hepner said she’s heard about legal heroin treatment being discussed for some time, but noted this is the first time she’s heard it publicly recommended.
She isn’t completely against it if it will save lives but, like Baker, she said the end goal should be to get addicts completely off drugs.
All agree something substantive has to be done about the increasing deaths among drug users.
“I’ve been told anecdotally that there is very little heroin on the streets any more,” Lapointe said. “Most of it is fentanyl.”
She noted in November that the coroner’s office created a Drug Deaths Investigation Team which is now looking at every drug-related death in 2016.
The team’s initial reports are expected to be made public in a couple of months.