by Eve Lacroix 

Back in September, Canada approved drug legislation allowing all Canadian physicians to apply to Health Canada for a special-access programme to prescribe pharmaceutical heroin to their patients.

For the past 11 years a small Vancouver clinic named Crosstown has been running a trial heroin maintenance programme. At Crosstown, 52 heroin addicts who have been unsuccessful in traditional treatment methods – such as using methadone clinics or detoxing with suboxone – are instead injected with the legal pharmaceutical-grade heroin known as diacetylmorphine free of charge. Similar injection clinics have existed for over two decades in Switzerland and in the Netherlands, but Crosstown is the first of its kind in Canada. The Washington Post reports that although the time commitment of the programme is heavy, demanding patients come into the clinic two to three times daily, “the patients are healthier, and participation in the programme drastically reduces their participation in criminal activities.” Crosstown’s lead physician, Scott Macdonald, has said that the majority of their patients are long-time users, and that his primary goal is “to get people into care.”

is it not better for them to have clean, reliable, medical access instead?

If an addict has not been successful with other rehabilitation or detox treatments and is inevitably going to keep using drugs illegally, is it not better for them to have clean, reliable, medical access instead? Their other option may be to rely on street drugs, which are often cut with harmful and poisonous components, and where variations in purity levels puts them at constant risk of overdosing. Treating users as people with health problems and not as criminals reduces petty crime and mass incarceration. Users incarcerated for the possession of drugs on their person are likely to reoffend, and under its War On Drugs approach, the USA has seen a seemingly endless cycle of of users detoxing in prison, finding a fix as soon as they are released, only to be re-incarcerated for further drug offences.  In fact, in 2015, 1.25 million people were arrested for the possession of drugs for personal use. The Human Rights Watch has released a statement that marijuana arrests outnumber the figures for all violent crime arrests put together. Despite these high figures rates of drug use have not gone down – and, in fact, overdoses have quadrupled over the past four decades.


Image credit: The Other Press

An even darker approach to drugs can be found in the Phillippines, where President Duterte appealed to his citizens and police officers a few months ago to enforce a witch-hunt of their own to kill all drug users. In his first address to his citizens, he implored them to kill drug addicts because “getting their parents to do it would be too painful” and continued to say that “We will not stop until the last drug lord, the last financier and the last pusher have surrendered or [been] put behind bars or below the ground.” Between July 1st and September 5, there has been an average death rate of 38 people per day and over 2,500 people have been murdered.

Whereas in 1992, one million needles were exchanged in Amsterdam, 2013 saw only 200,000.

Contrast this with the situation in the Netherlands, which has taken a public health approach to drug addiction. Since starting programmes in the 1990s all over the country such as methadone clinics, needle exchange programmes, and injection centres where heroin addicts can come and inject or smoke government-supplied heroin, heroin use has dropped significantly. Whereas in 1992, one million needles were exchanged in Amsterdam, 2013 saw only 200,000. In 2014, most heroin addicts were over 40 and Vice Media reports that “heroin use under 30 is practically non-existent.”

While the UK’s take on drugs currently falls somewhere between the two extremes of criminalisation and complete legalisation, in future policy decisions I urge the UK to look into the more successful treatment programmes found in the Netherlands, Switzerland and Canada – amongst others – to recognise the benefits of not only decriminalising but actually proceeding to legalise drugs altogether.



    * Crime Issues: 60% drop in felony crimes by patients (80% drop after one year in the program). 82% drop in patients selling heroin.

    * Death Rates: No one has died from a heroin overdose since the inception of the program. The heroin used is inspected for purity and strength by technicians.

    * Disease Rates: New infections of Hepatitis and HIV have been reduced for patients in the program.

    * New Use Rates: Slightly lower than expected. 1) As reported in the Lancet June 3, 2006, the medicalisation of using heroin has tarnished the image of heroin and made it unattractive to young people. 2) Most new users are introduced to heroin by members of their social group and 50% of users also deal to support their habit. Therefore, with so many users/sellers in treatment, non-users have fewer opportunities to be exposed to heroin, especially in the rural areas.

    * Cost Issues: 48 dollars/day: Patient costs are covered by national health insurance agency. Patients pay 700 dollars/year  for the compulsory insurance. Note: The Swiss save about 38 dollars per day per patient mostly in lowered costs for court and police time, due to less crime committed by the patients.

    * In December 2008 the Swiss voted (68%-32%) to make the program part of their body of laws.

    Heroin assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands and Denmark. Additional trials are being carried out in Canada and Belgium.

    A clinical follow-up report on the German “Heroinstudie” found that 40% of all patients and 68% of those able to work had found employment after four years of treatment. Some even started a family, after years of homelessness and delinquency.

    In the Netherlands, both injectable Diamorphine HCl as injectable salt in dry ampoules as well as Heroin base with 5-10% caffeine for vaporization are available.


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