Really, what we need, as we have for other diseases, is a stepped care model. Some people who are opioid-addicted actually don't need Suboxone. They don't need a medication. By going to a peer support meeting or going into a recovery program, they will go into long-term recovery. They don't need an intensive medical approach.
For other people, Suboxone would be effective. If that's unsuccessful, by the current Vancouver Coastal guidelines we would look to methadone. There are other new emerging therapies using long-acting oral morphine as an agonist therapy that can extinguish illicit drug use.
For some people—again, it's almost an inconsequential fraction of the population in terms of population size—in terms of costs, it can be extremely costly. These are individuals with huge histories of trauma, oftentimes fetal alcohol syndrome, other sorts of diseases of the brain that result in compulsive behaviour, or hypoxic brain injuries. For those people, the science would suggest that for very tightly controlled programs where people get diacetylmorphine—“Heroin” is actually the trade name of a drug that was once marketed by Bayer Pharmaceuticals—there is a role. It's not like we're talking about heroin programs rolling out across the country in suburban areas, but for a sliver of the population it can add a great deal of public health and public safety in terms of being able to successfully engage people in a program. For many others, a huge group, no medication might be required.
As my colleague has alluded to, those programs don't exist, so it's really a comprehensive approach and an evidence-based medicine approach. There's a Cochrane Collaboration meta-analysis looking at the trials of diacetylmorphine prescription in demonstrating the benefits. I'd refer to that.