The Role of Heroin Assisted Treatment in Combating Vancouver Overdoses

With overdoses spiking recently in Vancouver due to a dangerous batch of heroin, it's worth considering the vital role that heroin assisted treatment could play in the future combating of these harms. 

Between October 12 and 13, 31 overdoses were registered at Vancouver's supervised injection facility, Insite. The 16 overdoses recorded in one day was a record, reported The Province, and above the average 10 to 12 usually registered per week. 

None of the 31 people who overdosed at Insite died, thanks to the medical staff on hand to assist them with oxygen and naloxone. Since it became North America's first ever legal supervised injection site in 2003, Insite has not registered a single death. 

Speculation was rife initially that the significant uptick was attributable to a "bad batch" of heroin being sold in the area. Vancouver police confirmed this in the following days, stating that samples of the heroin responsible had tested positive for the synthetic opiate fentanyl, a drug that is approximately 100 times more potent than heroin. 

One way in which events like this could be avoided to a degree in the future is through the introduction of Heroin Assisted Treatment (HAT), something which has been a particularly contentious issue in the province of British Columbia (B.C.) in the past year. HAT programs are typically offered to people suffering from problematic heroin use who are resistant to other harm reduction measures, for example, methadone maintenance treatment (MMT). HAT has been shown in other countries to have a significant impact on improving the health and long-term stability of people under such programs. Furthermore, it provides users with a far safer option to injecting street heroin and thus significantly lessens the incidence of overdoses. 

HAT in British Columbia has been offered in recent years through the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), one which is slated to run until 2015. However, in October last year, Canada's federal government ordered that doctors could no longer prescribe heroin in the country, despite the promising outcomes of SALOME in treating chronic heroin users. 

Following a legal challenge to Health Canada's decision, the B.C. Supreme Court granted an injunction in May this year, allowing for prescriptions to go ahead. This means that some 200 former participants in SALOME will now be eligible to receive prescribed heroin toward the end of this year, and will be the first such group to do so outside of a clinical study. 

Of course, the number of people who will benefit from this treatment is a drop in the ocean in the wider context of heroin users in B.C. However, if it goes at least some way toward removing people from the recently evidenced dangers of using street heroin, this can only be a good thing.