Canada’s government discreetly made prescription heroin legal on Tuesday, opening up a desperately needed channel for addressing severe addiction. Spearheaded by the nation’s supremely woke Prime Minister, Justin Trudeau, the decision reflects the government’s increasingly progressive and science-based approach to viewing drug addiction — one that emphasizes public health over criminalization. For addicts in Trudeau’s Canada, the poison might also be the cure.
Now, under the newly approved drug regulations, which were first reported by the Washington Post on Tuesday, Canadian doctors can prescribe pharmaceutical-grade heroin to addicts that have exhausted all other options for treatment. Typically, these involve weaning users with methadone, an opioid that prevents some of heroin’s withdrawal symptoms without the high, together with rehabilitation. These don’t always work because users looking for a proper fix often drop out of treatment before it can become effective.
Trudeau’s government has flirted with the idea of legal heroin since May, motivated by the need to mitigate the stringent anti-drug laws instituted by the nation’s former Conservative government and buoyed by the success of the country’s existing legal injection sites. At these clinics — like Vancouver’s pioneering Crosstown Clinic, open since 2005 — severely addicted users receive up to three nurse-administered doses of pure heroin a day, which are crucial in keeping the treatment program’s dropout (and infection) rate low.
Under the new laws, physicians will still have to apply to Health Canada for access to the high-grade heroin, but empowering them to prescribe it is an early and extremely important step in dismantling an outdated drug regulatory system that has clearly failed to treat and prevent addiction. Canada joins eight other countries, all in Europe, that have adopted similar health-based approaches to dealing with chronic opioid abuse.
The decision reflects the willingness of Trudeau’s government to consider science over popular misconceptions, which strongly suggests that heroin can and should be reframed as a tool for rehabilitation. The key to treating heroin addiction, it seems, is making sure patients stay in treatment, which, in turn, takes time. During that fragile time, the temptation to return to illegal heroin (and the illegal means to get it) is great — especially so when weaker, substitute opioids are all that’s available. In a 2009 article in the New York Times about the benefits of legal heroin — then a fairly new idea in the science community — one doctor summed up the biggest problem with methadone maintenance: “[Many] patients don’t want to take it; they just don’t like it.”
For lack of any other options, doctors have no choice but to view heroin itself as a form of treatment. One Danish article, published in the journal Culture, Medicine, and Psychiatry in 2015, outlined the usefulness of medically prescribed heroin as part of the “process of altering the heroin from drug to medicine.” Similarly, a Canadian study, published in the New England Journal of Medicine in 2009, reported that treating severe heroin addicts with their drug of choice instead of methadone was a better way of ensuring they’d remain in their treatment programs. In the trial, patients who received injectable diacetylmorphine were also more likely to reduce their use of illegal drugs and participate in other illegal activities than those that received oral methadone. This has also been shown to be the case in Switzerland and the Netherlands, where prescription heroin has been legal for years.
It’s interesting to note that in many of these studies and in the Canadian ruling, the pharmaceutical-grade heroin is referred to by the chemical name of its high-inducing chemical diacetylmorphine — and not its street name. This suggests that, like CBD from marijuana and mitragynine from kratom, it’s the active ingredient, not the drug itself, that’s medically important. When we “pharmacologize” heroin, we feel less conflicted about using it as medicine.
This is not to say that heroin is any less dangerous than we thought. Quite the contrary: Between 2007 and 2014, the number of deaths involving heroin in the United States tripled, from 3,036 to 10,574, the DEA reports. These days, street heroin is being cut with the synthetic super-opioid fentanyl, which makes it even more deadly — and, to the severely addicted, perhaps even more appealing. But with street heroin becoming an increasingly dangerous threat to addicts old and new, is it really such a bad idea to use prescription heroin as a tool to keep them off the streets?Photos via Getty Images / Pool, Getty Images / John Moore