The potential health and economic impact of implementing a medically prescribed heroin program among Canadian injection drug users

Abstract

Objective: To model the potential health and economic impact of implementing a Medical Heroin Prescription Program (MHPP). Methods: We modeled the potential impact of a MHPP over a 5-year period. Participants were eligible if they had injected illicit drugs for greater than 5 years, injected heroin at least daily, resided in Greater Vancouver, and have previously failed Methadone Maintenance Therapy. Parameter estimates were obtained from the Swiss Heroin Trial study monograph. The potential impact was estimated by comparing hospitalization, emergency room use, and criminal activity costs and employment numbers in a MHPP and non-MHPP scenario. Two models were developed, one for eligible Vancouver Injection Drug Users Study (VIDUS) participants and one for eligible injection drug users in Greater Vancouver. Results: A total of 356 (25%) of the 1400 participants in VIDUS were potentially eligible. The MHPP scenario led to a notable decrease in hospital days (from 4041 to 1477) and emergency room visits (from 3088 to 1129) as well as criminal charges (from 1343 to 516) among eligible VIDUS participants over the study period. Employment moderately rose from 4.8% to 7.1%. The implementation of an MHPP could potentially decrease hospital, emergency, and criminal activity costs by a 63% reduction, or $9650 per treated subject. Estimated total cost savings for Greater Vancouver ranged from $6 957 000 to $9 050 700. Conclusion: Our model indicates that notable health and economic benefits could potentially occur by implementing a programme that prescribes medical heroin to chronic injection drug users in Canada.