How Canada’s Addiction Treatment Approach Compares to the U.S.

How Canada's Addiction Treatment Approach Compares to the U.S., Lynn R Webster, @lynnrwebstermd

Canada and the United States are good neighbors, and share many values.

Although Canada and the United States are part of the North American family, and we feel a kinship to them in so many ways, we have different mindsets about some key issues. Specifically, we do not feel the same way about some healthcare issues.

Differing Treatments to Heroin Addiction 

Canada seems to be more progressive than the U.S. and is quicker to see the needs that the U.S. denies — for example, the treatment of heroin addiction with heroin, and the potential benefits of medical marijuana.

Both Canada and the Unites States have suffered from the opioid epidemic. The U.S. spends more than 72.5 billion dollars annually on opioid addictions. In Canada, the drug programs spent 93 million dollars on medicines used to treat addictions to painkillers in 2014. In both countries, illicit prescription opioid use has led many people to use heroin. We’re now in the unfortunate position of having to combat the heroin problem in both countries, and we’re taking two distinct paths.

Canadian Approach — Prescribing Heroin

In Canada, as ABC News recently reported, doctors can now legally prescribe heroin to some patients to treat addiction. Canadian doctors can prescribe diacetylmorphine — which is prescription-grade heroin — through Canada’s Special Access Programme (SAP) to treat patients with heroin addiction. According to the Health Canada Web site, the SAP drugs “may only be sent to the practitioner’s office or in-patient pharmacies.” Manufacturers aren’t allowed to send SAP drugs to retail pharmacies.

Prescribing to heroin users with prescriptions for heroin is something the United States has not done, nor is likely to do in the near future. There may be justifiable objections to prescribing heroin, but the U.S. doesn’t seem to be interested in hearing formal arguments for, or against, it.

U.S. Trying Innovative Approaches

However, we are trying innovative approaches to treat people with heroin addiction here in the United States, too. For example, King County in Seattle, Washington hasn’t yet legalized heroin treatment centers. But, during an NPR Morning Edition Sunday interview, King County’s health officer Jeff Duchin said that the proposed safe consumption sites are “not really to give people a place to inject drugs and then go about their lives, but really a way that they can inject safely off the street, out of doorways, out of alleyways — hygienic conditions to minimize their risk of infection, such as HIV; to minimize their risk of overdose, and to minimize the stigmatization and social rejection that keeps a lot of these people out of the health care system in the first place.”

These locations, according to Duchin, would not provide heroin to users. Rather, users would have access to health care providers which is the first step toward getting them into treatment. In other words, some locations in the United States are trying to find treatment options for people with heroin addiction that will be acceptable to the heroin users.

Legalization of Marijuana 

Another healthcare matter on which Canada and America are moving forward separately is the legalization of medical marijuana. On August 24, 2016, the Access to Cannabis for Medical Purposes Regulations came into effect in Canada. That replaced Canada’s Marijuana for Medical Purposes Regulations which was implemented in 2001.

The updated Access to Cannabis for Medical Purposes Regulation means that, “Individuals with a medical need, and who have the authorization of their health care practitioner, will now be able to access cannabis in three ways: they can continue to access quality-controlled cannabis by registering with licensed producers, they can register with Health Canada to produce a limited amount for their own medical purposes, or they can designate someone else to produce it for them.”

By contrast, the United States’ medical marijuana laws vary from state to state. Yet, federal law prohibits the use of marijuana in any form. Despite the federal law, there are 25 states where medical marijuana is deemed legal, and it’s also legal in DC. However, people with chronic pain who may benefit from cannabis and live in a state where medical marijuana is illegal have one choice for accessing cannabis: to break the law. That seems to be a lose/lose proposition for people in pain and our criminal justice system.

Which Addiction Treatment Approach is More Effective? 

Are Canada’s policies regarding distributing heroin to people with heroin addiction, and legalizing medical marijuana to those in need, better than our U.S. policies? That debate should include the  scientific community and not be left to law enforcement to decide.

Of course, there needs to be more research that would ultimately lead to more, and better, options for people with addiction and people in pain. But those treatment options must also be affordable for everybody who needs them.

Only time will tell if the Canadian approach is better. The question is this: if Canada’s approach does appear to do a better job of addressing opioid addiction and pain than our way, will the U.S. be willing to learn and adopt new policies? Admitting that we can improve our approach by watching the way others handle health care matters is a good starting point.


Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.

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Copyright 2016, Lynn Webster, MD

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