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Drug users should be able to get heroin from the health system

BMJ 2015; 350 doi: (Published 14 April 2015) Cite this as: BMJ 2015;350:h1753
  1. Martin T Schechter, professor, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
  1. martin.schechter{at}

Politicians may not like it, but evidence shows that giving heroin to some users reduces harm, argues Martin T Schechter

At first glance, the idea of heroin assisted treatment may seem preposterous. Rona Ambrose, Canada’s health minister, certainly thinks so. When physicians in Vancouver continued to prescribe heroin on compassionate grounds to a small number of patients who had benefited from it in a clinical trial, essentially implementing the first heroin prescription programme in North America, the minister changed some regulations to try to end the practice.

“The prime minister and I do not believe we are serving the best interests of those addicted to drugs and those who need our help the most”—said Ambrose in October 2013—“by giving them the very drugs they are addicted to.” Similarly, John Walters, the US drug czar under President George W Bush, called such harm reduction activities “state assisted suicide.”

However, before responding with a similar knee jerk reaction, pause to consider an especially vulnerable subgroup of people with heroin addiction. I refer to those with longstanding illness for whom our best available treatments, such as detoxification, abstinence programmes, and methadone maintenance, have …

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