Today (March 25), Providence Health Care enters the B.C. Supreme Court with a request that doctors be allowed to prescribe a special class of patients diacetylmorphine, or pharmaceutical heroin.
Federal health minister Rona Ambrose has strongly opposed the plan to provide heroin-assisted therapy in Vancouver.
Since her first move against it, in October 2013, the Straight has attempted to learn how the federal government arrived at its position, which contradicts a growing body of scientific evidence. Despite repeated requests, Health Canada has not provided anything specific in the way of academic studies or the opinions of experts.
The case entering the courts today concerns past and present patients enrolled in the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), which is underway at Providence Crosstown Clinic in the Downtown Eastside.
B.C. doctors are seeking an injunction that would allow them to prescribe diacetylmorphine to former SALOME patients after they have exited the trial. (An in-depth article exploring the program’s merits is available here.)
The plan has the support of B.C. health minister Terry Lake, federal NDP health critic Libby Davies—who represents the Downtown Eastside—as well as former Vancouver mayors Philip Owen and Sam Sullivan. Prominent B.C. physicians have also voiced their support, including bestselling author Dr. Gabor Maté, and doctors Evan Wood and Thomas Kerr, co-directors for the Urban Health Research Initiative at the B.C. Centre for Excellence in HIV/AIDS.
None of that has swayed the resolve of Canada’s health minister, who in October 2013, amended the federal special access program to prevent clinicians from administering drugs such as heroin, cocaine, and ecstasy (MDMA).
On March 21, Ambrose was in town for a lunch with the Vancouver Board of Trade. After the event, she took questions from two reporters in attendance. Four questions were allowed, all of which were related attempts to understand how the federal government is making decisions on heroin-assisted therapy and harm reduction policies in general.
Ambrose was asked to address criticisms that policies related to the prescription heroin issue were based on ideology as opposed to science.
“There are scientists and researchers, clinicians, who have worked in the area of addictions for decades, who believe that this is a good decision,” Ambrose responded. “I’m happy to provide you with some their accounts.”
The Straight has repeatedly requested that information. Health Canada’s media team has never provided it. Another request was filed on March 21; no reply has come.
Ambrose was next asked to respond to a common argument made by advocates of heroin-assisted therapy; that it’s generally reserved only for severe addicts who have repeatedly failed with traditional treatments such as methadone.
“I want them to seek a treatment for their heroin addiction that is safe,” Ambrose said. “And I’m not going to give up on them.”
The health minister was then asked directly to list the scientific information or experts’ opinions on which her opposition to prescription heroin was based.
“This special access program specifically around which this decision is made, is not intended to provide drugs to people who are addicted to drugs,” Ambrose said. “It’s intended to provide treatments that are not approved in Canada yet, for people suffering from rare diseases and critical conditions like cancer. The intention of this program is not to provide heroin to those addicted to heroin.”
Finally, Ambrose was asked if, in shaping federal policies on harm reduction, any health-care professional in Vancouver were ever consulted, given this city’s lengthy history with programs such as Insite, North America’s only legal supervised injection facility.
“Again, the special access program is intended for those who are in critical condition, to look at whether or not we can allow a physician access to an unapproved drug,” Ambrose responded. “It is not intended to provide heroin to those who are addicted to heroin. I have a very strong belief that we need to reach out to people that are addicted and we need to help them seek treatment, help them get safe treatment, and hopefully, in the end, they will find a life of recovery.”
Those are all questions that the Straight has repeatedly put to Health Canada over a period of several months. Answers have never been provided.
Following up on the minister’s offer to provide information related to the crafting of federal policies on harm reduction, the Straight again submitted a request to Health Canada’s media team. A response from ministry spokesperson Michael Bolkenius provided a single link to a February 14, 2014, article published at CanadianHealthcareNetwork.ca. A request for information from a date relevant to Health Canada’s October 2013 move against prescription heroin was not returned.
By Travis Lupick
Photograph; Rona Ambrose visits the University of Alberta
25 March 2014