The Providence Crosstown Clinic is open every single day of the year, Dr. MacDonald explains. Each patient gets a scheduled time to come in; most come two or three times per day. Once inside, they go through a quick assessment to make sure they're well enough to proceed. Then, they are given seven minutes to use their drug under supervision, and clinic staff watches over them for another 15 minutes to make sure they're okay. The whole thing takes about 30 minutes.Treatment with medical-grade heroin has already existed in various experimental forms for decades in other countries, such as Germany, Switzerland, and ( more controversially ) the U.K.Research looking at those sites has shown that treatment with diacetylmorphine is at least as effective as methadone at keeping patients in counseling and, eventually, reducing their opioid use "It gets people off the streets, it helps them to stop using heroin and opioids, and it's cost-effective," says Dr. MacDonald. "The main benefits are saving lives and reducing costs [within the criminal justice system], and the secondary benefits are reducing social disorder, such as crime. There are many benefits, both to the individual and society."In the U.S., patients are already going to clinics daily to get methadone or suboxone, explains Dr. MacDonald, "so this is an intensified version of that." Although it wouldn't be too much of a logistical hassle to simply add the medical-grade heroin as another medication option, he points out that it would still require some serious regulatory changes. Right now, this practice is illegal.Ideally, introducing this type of treatment would occur alongside other evidence-based harm-reduction techniques, such as expanding access to the overdose-reversal drug naloxone and creating more supervised injection sites "There’s a variety of services, and we can provide comprehensive care," says Dr. MacDonald. That includes treatment for things like HIV, diabetes, high blood pressure, and mental illnesses. And should a patient wish to cut back his or her use or step down to suboxone or methadone at any point, Dr. MacDonald says the staff are more than happy to help with that, too.