New B.C. guidelines unveiled for prescription heroin

The BC Centre on Substance Abuse Use (BCCSU) has announced B.C.’s first ever guidelines for injectable opioid treatments.

B.C. addictions expert, Dr. Seonaid Nolan says this is a step in the right direction.

Dr. Nolan, addiction medicine physician at St. Paul’s Hospital and a clinical researcher at the BC Centre on Substance Use spoke with CKNW’s Jon McComb on Thursday about using prescription heroin to treat opioid addiction.

“I think it’s natural for people to be hesitant about prescribing this form of therapy. I think what we need to keep in mind is the context with regards to our current public health crisis. Four British Columbians are dying every single day from an overdose,” she said.

Dr. Nolan said there are many reasons for this type of treatment to be successful.

“These injectable treatments, both injectable Hydromorphone and prescribed Heroin have been studied very rigorously and have been shown to be very effective in retaining individuals in addiction care and receiving addiction treatment. They’ve been shown to reduce intersection with both the criminal justice system and the health care system.”

According to Dr. Nolan, heroin-assisted treatment trials have existed in Europe for decades.

“Here in North America, Providence Crosstown Clinic is the first clinic to prescribe such therapy and the SALOME study was a randomized control trial really looking at the effectiveness of injectable Hydromorphone and comparing it to injectable Heroin,” she said.

Nolan said this form of therapy should be reserved for those who have been unsuccessful with treatment options such as Methadone and Suboxone.

“Injectable therapies are really just another tool we should be utilizing and offering to patients to try and engage them in care and help treat their underlying addictions.”

How we view addiction should be likened to how we treat chronic disease, according to Nolan.

“And just like any other chronic disease like hypertension or diabetes, certain individuals will do quite well on one form therapy and others not so much.”

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When asked if this would attract drug users from across the country, Nolan said there was no evidence to suggest so.

“In my opinion not rolling them out and expanding access to those treatment programs is quite frankly unethical, and I really think now is the time to be acting to improve access to these life-saving medications.”

Nolan said the goal is to transition hardcore users from programs like prescription heroin into addiction treatment.

“And eventually, to transition individuals if willing and able to an oral form of therapy whether that be oral Hydromorphone, oral Methadone, or oral Suboxone.”

When asked if the public is becoming more accepting of drug addiction as a medical problem, Nolan said the challenge is overcoming the perception that addiction is a lifestyle choice.

“The evidence that we’re seeing in terms of the reward pathway and the underlying physiology with regards to the disease of addiction it’s clear; this is a medical condition, addiction is a disease of the brain.”

The guidelines for the program are fairly widespread according to Nolan.

“These programs can be tailored to exist in communities that may not have as much rigorous support as say Vancouver would.”

For Nolan, The Ministry’s endorsement was a very important step.

“Working at St. Paul’s Hospital I can tell you without a doubt that there are so many individuals who have really attempted therapy with Methadone and Suboxone and have been unfortunately unsuccessful and who I would believe would benefit from having access to these therapies.”