The Role of Diacetylmorphine in the Safer Supply Response to the Toxic Drug Crisis
The ongoing toxic drug crisis has claimed thousands of lives due to an unpredictable illegal drug supply contaminated with highly potent synthetic opioids like fentanyl. One approach that shows promise in reducing overdoses and other harms is providing a safer supply of regulated controlled substances to people who use drugs.
Diacetylmorphine, also known as pharmaceutical-grade heroin or prescription heroin, is emerging as a key safer supply option. As an opioid medication regulated for medical use in some countries, diacetylmorphine provides an evidence-based alternative to the unpredictable illegal heroin supply.
Unlike illegal heroin, which may contain unknown adulterants and widely varying potencies, prescribed diacetylmorphine is pharmaceutical-grade with a known dosage and composition. This reduces the risks of overdose, disease transmission from contaminated drugs, and other harms associated with the illegal drug market.
The highly potent synthetic opioid fentanyl, which has contaminated much of the illegal opioid supply, is driving the catastrophic overdose death toll. Fentanyl is so potent and compact that it has also infiltrated other illegal drug supplies beyond just opioids, killing people who don’t realize they are consuming it.
It has been detected in supplies of cocaine, methamphetamine, MDMA, cannabis and other drugs. Repeated fentanyl overdoses and its long-term effects like respiratory depression, brain injury from hypoxia, and infectious disease risks from IV use take an immense toll. Additionally, tolerance to fentanyl increases exponentially over time compared to heroin, making it extremely dangerous as higher doses are required. In contrast, diacetylmorphine/heroin does not exhibit the same rapidly increasing tolerance.
Several studies, including clinical trials in Canada, Switzerland, the Netherlands and the United Kingdom, have demonstrated the efficacy and safety of diacetylmorphine-assisted treatment for people with severe opioid use disorder who have not benefited from other treatments like methadone. Providing diacetylmorphine allows people to receive their treatment in a medical setting and connects them with healthcare professionals.
As the toxic drug crisis continues unabated, a regulated safer supply of diacetylmorphine and other medications shows promise as part of a public health approach to reduce harm and provide an exit from the unpredictable illegal drug market. More jurisdictions should explore prescribed diacetylmorphine as an emergency response.