Last Friday, Health Canada used some creative rule-reading to approve a program that would provide prescription heroin to a small number of hard-core users, and the Conservative health minister isn't happy. But doctors, advocates, and the users themselves are quite pleased — and once again, Canada stays on the cutting edge when it comes to dealing smartly with heroin use.

Health Canada approved access to prescription heroin for at least 15 people who are completing their participation in Vancouver's Study to Assess Long-term Opioid Dependence (SALOME), which is testing whether prescribing heroin was more effective than prescribing methadone for users who have proven resistant to conventional treatments. The move came after participants and advocates have been calling for an "exit strategy" for the 322 people in the study.

SALOME began at the end of 2011 and has been enrolling participants on a rolling basis for a year at a time. The final group of participants will finish up at the end of next year. It built on the success of the North American Opioid Maintenance Initiative (NAOMI), a study in Vancouver and Montreal from 2005 to 2008. That study found that using heroin is cheaper and more effective than using methadone to treat recalcitrant heroin users.

While the Conservative federal government has been a staunch opponent of heroin maintenance, not to mention also fighting a bitter losing battle to close down the Vancouver safe injection site, Health Canada bureaucrats were able to find a loophole that will allow doctors to prescribe heroin to graduating study participants under the ministry's Special Access Program (SAP).

That program is designed to provide drugs to Canadians with life-threatening illnesses on a "compassionate or emergency" basis. The SAP includes "pharmaceutical, biologic and radiopharmaceutical products that are not approved for sale in Canada." The program covers diseases including intractable depression, epilepsy, transplant rejection and hemophilia, but heroin addiction isn't mentioned.

"Health Canada made a wonderful decision," said Scott Bernstein, Health and Drug Policy Lawyer for the Vancouver-based Pivot Legal Aid Society, which represents 22 SALOME participants and the BC Association of People on Methadone in order to advocate for their continued access to health care and the protection of their human rights. "The decision was one based on the evidence and not ideology. It means that those SALOME participants allowed access can live safer, more stable lives, lives free of crime and remaining under the care of doctors, not drug dealers."

But Health Minister Rona Ambrose appeared to have been caught flat-footed by the Health Canada decision. She issued a statement the same day decrying the move, saying that it contradicted the government's anti-drug stance.

Pharmaceutical diacetylmorphine AKA heroin (wikimedia.org)