Perhaps to no one’s surprise, it turns out that supplying heroin to people without breaking the law is not an easy or a simple thing to do.
Since November 2014, a program run out of a clinic in Vancouver’s Downtown Eastside has done just that—that is, giving chronic addicts free prescription heroin, otherwise known as diacetylmorphine. But there was recently a hitch in the supply chain, which effectively put the harm-reduction initiative called heroin maintenance on hold.
David Lefebvre, a spokesperson for its operator, Providence Health Care, told the Straight that “due to a permit issue”, doctors at Crosstown Clinic had to transition patients to another drug called hydromorphone, a synthetic derivative of morphine. He noted that for some addicts, the change has been a struggle.
“This is the first time in North America that any clinic has provided diacetylmorphine to people who have chronic heroin addictions and that is a process that is extremely complex,” he said in a telephone interview.
Lefebvre explained that Crosstown was forced to begin transitioning patients roughly two weeks ago and hopes to have a majority of those people back on diacetylmorphine when a shipment of the drug arrives from a supplier in Europe “sometime in mid-September”.
“The reality is, the movement of diacetylmorphine is governed internationally, so it is so much more complex than people realize,” he explained. “It is not just a national issue with Health Canada, it is not just a national issue with the Office of Controlled Substances. It is also an international issue.”
Lefebvre said where exactly in the supply chain this problem occurred is in transit at a point across the Atlantic Ocean.
“The permit system in Europe takes six to eight weeks for drugs to be exported to Canada,” he said. “That results in delays that affect our ability to provide diacetylmorphine to our patients. Due to this time lag, Crosstown has had to transition some patients onto hydromorphone.”
Lefebvre cautioned that even after Providence receives its next shipment of diacetylmorphine in mid-September, the same problem could occur again.
“We are expecting continued issues with regard to supply due to this importation time lag,” he conceded.
Lefebvre acknowledged that for many long-term addicts, the transition off of heroin, even to another opiate such as hydromorphone, is not a painless experience. “We appreciate that this is challenging for them,” he said.
In past interviews, Lefebvre stressed that heroin-assisted treatment is only recommended as an appropriate intervention for individuals who have repeatedly failed with traditional therapies such as methadone.
In accordance with a B.C. Supreme Court injunction granted in May 2014, to be eligible to receive prescription heroin, a patient must have participated in the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), an academic program that began at Crosstown Clinic in 2011. The average SALOME participant has failed with traditional treatment for opioid dependence an average of 11 times.
The number of eligible past SALOME participants is 202. Of that group, Lefebvre said doctors have written diacetylmorphine prescriptions for 120 patients. He declined to specify how many of that group were affected by disruptions in the supply chain.
Health Canada has steadfastly opposed Vancouver’s prescription heroin program. The province’s Health Minister, Terry Lake, has stood behind regional authorities and supported it.
This article originally appeared online at Straight.com on August 5, 2015.