Here’s how programs that offer prescription heroin, or heroin-assisted treatment (HAT), work. Patients typically get a regular, measured dose of pharmaceutical-grade heroin — also known as diacetylmorphine or diamorphine — and inject it under close medical supervision inside a designated clinic. The idea is if people have a legal source of heroin, they’ll be less likely to overdose on tainted street drugs, spend less time and energy trying to get their next fix, and instead be able to focus on the underlying drivers of their addiction.

“This is just another treatment that could help stabilize lives,”says Kilmer.

It’s not meant for everyone. Medications like methadone, buprenorphine and naltrexone are highly effective treatments that function in different ways to address cravings and withdrawal symptoms or block the effects of drugs. But these first-line treatments don’t work for some longtime opioid users. In Canada’s main study of prescription heroin, eligible patients had already tried quitting heroin an average of 11 times.