Treating Heroin with … Heroin?

The latest treatment for heroin addiction could be heroin itself.

In the U.S., heroin use surged 63 percent between 2002 and 2013.

Health Canada, Canada’s government health department, recently announced it wants the federal government to let doctors prescribe medical-grade heroin — or Diacetylmorphine — to treat addiction. In 2013, Health Canada banned its usage, but new leaders want the drug put back on a list where it can be distributed on a case-by-case basis.

The treatment is already available in Switzerland, Germany, and the Netherlands. In those countries, the drug is permitted for a small number of addicts who don’t respond to alternative treatments such as Methadone.

Is it a dangerous precedent to set, though — treating an addiction with the drug that causes it?

Previous research has indicated injectable Diacetylmorphine hydrochloride is effective when delivery is supervised, but regulatory challenges have made it hard to approve in many countries. Other existing pharmaceutical treatments for heroin addiction include Methadone (Dolophine or Methadose), Buprenorphine (Subutex) and Naltrexone (Depade or Revia), the National Institute on Drug Abuse reports.

Special Cases Only
Canada will likely reauthorize its usage, Dr. Eugenia Oviedo-Joekes, the lead investigator in two recent heroin treatment studies, told LifeZette. “It’s a done deal,” she said. She expects the government to approve it in the coming weeks.

The drug won’t be available to just anyone, she noted. The country will make it available through the special access program, where doctors will have to approve it for patients on a case-by-case basis. In the U.S., the Food and Drug Administration has a similar program — dubbed “compassionate use” — to grant authorization to individuals for drugs that are in the midst of the approval process.

Oviedo-Joekes said doctors will have the ability to suggest the patient be able to obtain the drug, and they do not have to prove the patient has tried other methods unsuccessfully.

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Oviedo-Joekes said many people who come into her clinic do not want oral medications and prefer injectables. For some, drugs like Buprenorphine and Methadone do work. Other people don’t want to try them because they know they’ll be more successful with Diacetylmorphine.

She would like to see people try approved treatments, but said she understands why more addicts want Diacetylmorphine: It produces effects that are closest to street heroin.

Diacetylmorphine can be delivered in a supervised environment where patients know they are getting an uncontaminated drug. On the streets, they often use heroin that can be tainted with other substances and distributed with unsterile needles.

“For those people, we need to offer an alternative,” Oviedo-Joekes said. When drug addicts are in the throes of addiction, this offers them the baby steps they need to break free, she claimed.

When drug addicts are in the throes of addiction, this offers them the baby steps they need to break free.

Patients who take Diacetylmorphine often use it for a while, then transition to other treatments to successfully break free of the addiction once and for all.

“We need to be more compassionate,” she said. “Society has forgotten them.”

Another Injectable Option?
Diacetylmorphine isn’t the only option for addicts who want an injectable. Last month, Oviedo-Joekes released a study in JAMA Psychiatry that reported that Hydromorphone, a licensed pain medication sold under the brands Dilaudid, Exalgo, and Palladone, could be used to treat heroin addiction.

“Our study shows that Hydromorphone is as effective as Diacetylmorphine, providing a licensed alternative to treat severe opioid use disorder. Providing injectable opioids in specialized clinics under supervision ensures safety of both the patients and the community, and the provision of comprehensive care,” she said in a statement.

She tested whether injectable Hydromorphone was just as effective as injectable Diacetylmorphine in addicts not responding positively to available treatments.

It’s another option for addicts, but she believes Diacetylmorphine should be an option, too. Oviedo-Joekes said she hopes the U.S. approves the drug on a special-access basis, even though it is not available legally in the U.S. to anyone.

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Several sources LifeZette reached out to in the U.S. could not comment because they were not well-versed on using Diacetylmorphine as a treatment.

Heroin Addiction on the Rise
About 2 percent of Canadians reported the use of illicit drugs, including heroin, in 2012, up from 1.9 percent in 2011, according to the Canadian Alcohol and Drug Use Monitoring Survey.

In the U.S., heroin use surged 63 percent between 2002 and 2013, the Centers for Disease Control and Prevention reports. In 2011, 4.2 million people — or 1.6 percent of Americans 12 and over — had used heroin at least once in their lives. About 23 percent of individuals who use heroin become addicted to it, the National Institute on Drug Abuse reports.