Vancouver has been the source of controversial approaches to drug addiction, notably the pioneering safe-injection site the federal government tried to shut down.
Now a study by researchers at Providence Health Care, which runs St. Paul's Hospital in downtown Vancouver, and the University of British Columbia concludes giving heroin addicts precisely what they crave is medically better and more cost effective than treating them with methadone.
The study, published this week in the Canadian Medical Association Journal, found that addicts using medically prescribed heroin (diacetylmorphine) lived slightly longer than those given methadone and cost society $1.1 million, compared with $1.14 million for methadone users.
"Cost savings in the diacetylmorphine cohort were realized primarily because of reductions in the costs related to criminal activity," the study found.
"The treatment actually saves money and provides better outcomes," health economist Dr. Aslam Anis, one of the study's researchers, told the Vancouver Province.
The study was based on findings from the North American Opiate Medication Initiative (NAOMI), the continent's first clinical trial of prescribed heroin, between 2005 and 2008. It also used administrative data from around British Columbia.
Anis, director of the Centre for Health Evaluation and Outcome Sciences at Providence Health Care, called the medical-heroin treatment a "no-brainer."
People in the NAOMI program had serious addictions and failed other treatment programs at least twice, he said. Prescribing them heroin cost more than methadone but kept them in programs and away from other drugs and dangerous activities, Anis told the Province.
"The retention rate in heroin was double what it is in methadone," he said.
Program participant Mark Fraser agreed.
"All the findings they have come up with scientifically I more or less knew from my interactions with people and my personal experience," Fraser, a heroin addict for 30 of his 46 years, told the Province.
Fraser, who works in addiction harm-reduction programs on Vancouver's drug-riddled Downtown Eastside, calls himself a "functioning addict."
Methadone didn't work for him.
"It's hard on your body," he said. "It's very debilitating — for me, anyways. It makes me very tired and apathetic. I have a hard time getting things done."
"The question I get most about heroin-assisted therapy is whether we can afford the increased direct costs of the treatment," said study co-author Dr. Martin Schechter. "What this study shows is that the more appropriate question is whether we can afford not to."