Étendre l’accès des usagers d’opioïdes à la diacétylmorphine et à l’hydromorphone au Canada

Maghsoudi et al. soulignent l’importance de la diversification des possibilités de traitement à base d’opioïdes dans le contexte de la crise canadienne des overdoses.Pour en savoir plus, en anglais, veuillez lire les informations ci-dessous.

By Nazlee Maghsoudi & Jeanette Bowles & Dan Werb

Abstract

The increasing incidence of fatal opioid overdose is a public health crisis in Canada. While buprenorphine/naloxone and methadone are the standard first-line of opioid substitution options, limitations, including difficulty achieving long-term retention for some people who use opioids, are well known. For this group, injectable diacetylmorphine or hydromorphone can achieve positive outcomes, including high retention rates, reduced use of unregulated opioids, and reduced criminal activity. In May 2019, Health Canada announced changes to increase the accessibility of diacetylmorphine and hydromorphone, and in September 2019, the CIHR-funded Canadian Research Initiative in Substance Misuse released a national clinical guideline for diacetylmorphine and hydromorphone as additional frontline substitution options. While these developments present opportunities for scale-up, significant financial, structural, and practice barriers continue to impede access. This commentary explores the current state of policy and practice for diacetylmorphine and hydromorphone as opioid substitution options in Canada, outlines the rationale for rapid expansion of access, and highlights clinical and policy changes that must be undertaken or the death toll will continue to rise.