Vancouver mayor Sam Sullivan has introduced a pilot program to determine whether prescribing oral stimulants can help people struggling with addiction to cocaine, methamphetamine and other illicit stimulants.

The program, the Chronic Addiction Substitution Treatment program (CAST), will administer oral doses of stimulant drugs through local pharmacies. CAST will target people who volunteer for treatment, giving priority to sex workers and those who are frequently arrested. The project also will include counseling and homelessness services. 

A similar trial focusing on heroin rather than stimulants is already underway in Vancouver and Montreal. This new initiative addresses the fact that addiction to cocaine, methamphetamine and other stimulant drugs is more widespread in Vancouver than heroin addiction. Sullivan said he chose to initiate this program to reach as large a number of chronic addicts as possible.

"The mayor’s bold initiative is precisely the sort of thing we should be trying in the United States," said DPA executive director Ethan Nadelmann. "The principal obstacle to making drug treatment more effective here in the United States is the unwillingness to experiment and innovate, mostly because of ignorance and ideological resistance. Canada offers lesson we ignore at our own peril."

Similar trials have been done, with successful results, in the United Kingdom and Australia, said Dr. David Marsh, an addiction medicine expert with the Vancouver Coastal Health Authority.  In the United States, the principal research on prescribing oral stimulants to treat addiction is taking place in Houston.

"Addiction is a complex problem which requires a continuum of responses. Examining the effectiveness of prescribing oral stimulants or alternative opioid agonists as maintenance treatment would be an important addition to the range of treatment options," said Marsh. "Just like any other new use of a medication, this will be subjected to the framework of a scientifically rigorous, ethically sound clinical trial designed to show benefits for the drug user and society."

Vancouver has a history of being on the cutting edge of innovative strategies to combat drug misuse. The city started the first syringe exchange program in Canada and the country’s first supervised safe injection site. Vancouver also is home to a clinical heroin maintenance program as well as a methadone maintenance program.