Health Canada approves injectable hydromorphone to treat opioid addiction

Health Canada has approved injectable hydromorphone — a drug commonly used to manage pain — to treat patients with severe opioid use disorder.

According to the department, the change makes Canada the first in the world to approve the drug for such use, all in an effort to get the tragic overdose crisis under control.

“Increased access to a safe supply of prescription opioids is an innovative tool that will help save lives,” said Health Minister Ginette Petitpas Taylor in a social media post on Wednesday

According to Health Canada, 10,337 people were killed by opioid-related drug overdoses between Jan. 2016 and Sept. 2018.

In Vancouver, Dr. Scott MacDonald has been running the Crosstown Clinic for about 14 years, where patients have been prescribed heroin and injectable hydromorphone beyond the regulated use approved by Health Canada.


MacDonald’s research helped make the case to health officials that the drug was effective for addiction treatment in certain, more severe cases.

Currently, there are 25 patients at Crosstown receiving hydromorphone, and 120 injecting prescription heroin.

“My hope is that [the Health Canada approval] will bring expansion, and that it will support health authorities and other provincial jurisdictions to start implementing these programs,” said MacDonald.

With off-label prescribing, MacDonald said doctors need to jump through more hoops, and carefully get consent from patients, making them aware that a drug isn’t being used for its approved purpose.

Off-label use refers to any use of a drug beyond what Health Canada has reviewed and authorized to be marketed in Canada.

“There’s a larger process to go through to use an off-label drug,” he said. “[Approval] is reassuring, and gives some protection to prescribers, nurse practitioners, physicians and pharmacists that it’s not just their decision — This has been reviewed and approved by Health Canada.”


Scott MacDonald is the lead physician at the Crosstown Clinic in Vancouver, B.C. He says there could be a few thousand people with severe opioid use disorder across the country who could benefit from injectable treatment like hydromorphone. (Rafferty Baker/CBC)

MacDonald estimated that 250 to 300 people across the country are now receiving hydromorphone to treat opioid use disorder, mostly in B.C, Ontario and Alberta. He said there is the possibility of a program starting in Quebec.

The new approval will increase those numbers, though MacDonald said it’s only a suitable treatment for five to eight per cent of people currently being prescribed other oral opioid treatments, like methadone and suboxone.

“This is not for a huge number of people, though it’s a small but significant number,” he said. “Here in Vancouver, maybe, we need 500, 600 treatment slots. Across the country, I think there may be a need for a few thousand.”

Health Canada’s new rules require that hydromorphone is administered under the supervision of a doctor trained in injectable opioid treatment with suitable experience.


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