The Canadian Institute of Health Research (CIHR) just released new guidelines to address the overdose epidemic killing seven Canadians per day. Despite being touted by the authors as a "cutting edge" approach to problematic opioid use, the guidelines only summarize what we already know about medications that have been prescribed for decades, and in the case of methadone, more than 50 years in Canada.
The guideline recommends that physicians use suboxone, as the first line of treatment. This drug contains two main ingredients, buprenorphrine, which works as a replacement for an opioid drug, and naloxone, which blocks the effects of any opioid drug that someone takes. For people on suboxone, using other opioid drugs and getting high becomes more difficult. This leads people to take higher doses of heroin or fentanyl, and increases the risk of overdose death.
These new guidelines for opioid substitution from the CIHR don't do nearly enough to remedy an epidemic spiraling out of control. Sadly, they will be the most widely available document in the country for physicians seeking education on how to support their patients at risk of overdose, and it will fall short of what is needed to end this overdose epidemic. These guidelines exclude almost any mention of injectable medications like heroin or hydromorphone. In the context of a drug supply that is contaminated, the exclusion of injectable medication options is a failure of public health institutions to respond to the overdose epidemic.
Based on research from the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) and the North American Opiate Medication Initiative (NAOMI) clinical trials, prescribing diacetylmorphine, the active ingredient of heroin, would save many lives.
This treatment has been proven to effectively lower illicit drug use and improve the quality of life of patients. It has also been proven to be effective at retaining patients on treatment who have been resistant to traditional treatment options in the past, the same people who are most vulnerable to overdose.
What's killing people is drug overdose and an apathetic government.
Dr. Perry Kendall, British Columbia's Chief Medical Health Officer has stated that there is enough evidence of its success, and that regulatory barriers make it difficult to import the drug. Former Health Minister Jane Philpott even stated publicly that prescription heroin could save many lives. Despite this, Canada's government has taken no additional steps to reduce the regulatory burden so people have access to prescription heroin.
Despite diacetylmorphine being on Health Canada's special access program for almost two years, not a single Canadian has received access to it, outside of the clinic that hosted NAOMI and SALOME. There remains no signal from our federal government that it will enhance access to lifesaving prescription heroin for people at risk of overdose. Clearly our government is not willing to move forward in making the systemic change required to address the overdose epidemic.
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It should shame this country to no end that our federal government, both politicians and bureaucrats alike, is still afraid to see this epidemic for what it is in reality. It's not trauma killing people, it's not loneliness killing people and it it's not mental illness killing people. What's killing people is drug overdose and an apathetic government.
No amount of treatment, or therapy will reconcile the fact that our government would rather watch as more than 4,000 people die this year than provide safer alternatives.
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