Addressing Unmet Needs in Public Health at the Lowest Possible Price
Fair Price Pharma Divisions
I. Pharmacy Services
Once sufficiently many clients have been identified throughout BC, FPP will be in position to provide compounded inhalable diacetylmorphine base (in a 3:1 mixture with caffeine) based on prescriptions. Sprinkle caps will be available in 4 doses of DAM (75mg, 100mg, 150mg, 200mg). These can be stored at room temperature for up to 6 months. Prescribers and agencies (clinics, NGO, medical practices, health centres, overdose prevention sites, safer consumption sites, etc.) who wish to provide access to this life saving treatment for their clients should consult the operational guidelines available here and contact FPP as soon as possible.
Soon after, FPP will be in position to also provide compounded immediate release (IR) and extended release (XR) oral capsules of diacetylmorphine hydrochloride.
Over the longer term of 18 to 24 months, FPP intends to register two different inhalable formulations of diacetylmorphine with Health Canada under the trade name Opiax. FPP will also seek licensure for our immediate and sustained release oral capsules of diacetylmorphine .
Dr. Perry Kendall
Dr. Kendall is the former and first Provincial Health Officer of the Province of British Columbia. It was Dr. Kendall who declared the opioid crisis to be a public health emergency in April 2016. Dr. Kendall has previously served as Medical Officer of Health for the city of Toronto from 1989-95 and as President of the Addiction Research Foundation of Ontario from 1995 to 1998.
Dr. Martin Schechter
Dr. Martin Schechter was a Lead Investigator of the NAOMI and SALOME trials that demonstrated the effectiveness of diacetylmorphine and hydromorphone for the treatment of opioid dependence. The trials pioneered the use of diacetylmorphine in North America and of hydromorphone treatment in the world.
Both Drs. Kendall and Schechter are faculty members of the School of Population and Public Health within the Faculty of Medicine at the University of British Columbia, and both are members of the Order of British Columbia.
The Evidence for Diacetylmorphine Treatment
- The Cochrane Collaboration: “The available evidence suggests an added value of heroin prescribed alongside flexible doses of methadone for long-term, treatment refractory, opioid users, to reach a decrease in the use of illicit substances, involvement in criminal activity and incarceration, a possible reduction in mortaliity; and an increase in retention in treatment.”
- The Canadian Agency of Drugs and Technologies in Health (CADTH): “The results of the economic evaluations, considering a lifetime time horizon and societal perspective, indicated that diacetylmorphine and hydromorphone treatments each provided more benefits than methadone treatment, and at lower cost for individuals who had previously used other treatment options. Based on incremental cost-effectiveness ratios, it was found that both diacetylmorphine and hydromorphone dominated methadone.” Note: In economic terms, a dominant strategy is one that produces better health outcomes at lower overall cost.
- Seven positive randomized controlled trials in six countries:
- Switzerland: Perneger TV, Giner F, del Rio M, Mino A. Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments. British Medical Journal 1998; 317(7150):13-8.
- The Netherlands: van den Brink W, Hendriks VM, Blanken P, Koeter WJ, van Zwieten BJ, van Ree JM. Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials. British Medical Journal 2003;327:310–6.
- Spain: March JC, Oviedo-Joekes E, Perea-Milla E, Carrasco F, PEPSA team. Controlled trial of prescribed heroin in the treatment of opioid addiction. Journal of Substance Abuse Treatment 2006;31(2):203–11.
- Germany: Haasen C, Verthein U, Degwitz P, Berger J, Krausz M, Naber D. Heroin-assisted treatment for opioid dependence. Randomised controlled trial. British Journal of Psychiatry 2007;191:55–62.
- Canada: Oviedo-Joekes E, Brissette S, Marsh DC, Lauzon P, Guh D, Anis A, Schechter MT. Diacetylmorphine versus methadone for the treatment of opioid addiction. New England Journal of Medicine 2009; 361(8):777–86.
- The United Kingdom: Strang J, Metrebian N, Lintzeris N, Potts L, Carnwath T, Mayet S, et al. Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial. Lancet 2010; 375:1885–95.
- Canada: Oviedo-Joekes E, Guh D, Brissette S, et al. Hydromorphone compared with diacetylmorphine for long-term opioid dependence: a randomized clinical trial. JAMA Psychiatry 2016; 73(5):447-455.
- Four positive economic evaluations in three countries:
- The Netherlands: Dijkgraaf MG, van der Zanden BP, de Borgie CA, Blanken P, van Ree JM, van den Brink W. Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials. British Medical Journal 2005; 330(7503):1297.
- Canada: Nosyk B, Guh DP, Bansback NJ, Oviedo-Joekes E, Brissette S, Marsh DC, Meikleham E, Schechter MT, Anis AH. Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment. Canadian Medical Association Journal 2012; 184(6):E317-28.
- Canada: Bansback N, Guh D, Oviedo-Joekes E, Brissette S, Harrison S, Janmohamed A, Krausz M, MacDonald S, Marsh DC, Schechter MT, Anis AH. Cost-effectiveness of hydromorphone for severe opioid use disorder: findings from the SALOME randomized clinical trial. Addiction 2018; 113(7):1264-1273.
- The UK: Byford S, Barrett B, Metrebian N, Groshkova T, Cary M, Charles V, Lintzeris N, Strang J. Cost-effectiveness of injectable opioid treatment v. oral methadone for chronic heroin addiction. British Journal of Psychiatry 2013; 203:341-9.
- The Case for Heroin Assisted Treatment in Canada (Pivot Legal Society, 2017)
- Open letter from the Honourable Patty Hajdu, Minister of Health of Canada from 2019-2021, concerning pharmaceutical-grade alternatives to the toxic drug supply (August 2020)
Hear from People with Lived Experience of Diacetylmorphine Treatment
Read a letter from someone who participated in the NAOMI trial of diacetylmorphine (redacted for confidentiality)