The case for a heroin substitution treatment trial in Canada.

Illicit opiate use in Canada causes considerable harm and social cost. Methadone substitution treatment, which has been proven effective in reducing the negative effects associated with opiate use, has been used in Canada, but so far only on a small scale. Recent research suggests that, while expanding the availability of methadone substitution is certainly in the public health interest, it would not be sufficient in itself to reduce to a minimum the harms from illicit opiate use. On the basis of the epidemiology of opiate use and of related harms, and building on the experience of intervention efforts currently underway elsewhere, this paper argues for the establishment of a heroin substitution trial in Canada. Such a trial should have the goal of investigating the potential of heroin substitution to significantly reduce the health and social costs to Canadians from illicit opiate use.