Canada's health minister fails to explain Ottowa's policies on harm reduction

By Hey :-) · Mar 26, 2014 · ·
  1. Hey :-)
    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 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
    Straight News

    Share This Article


  1. Hey :-)
    Gabor Mate: A letter to Rona Ambrose, Canada's ''minister of disease''?

    As a member of the federal government, you are currently titled Canada’s health minister. I question the accuracy of that nomenclature.

    You have recently taken it upon yourself to void a decision by Health Canada, the public agency granted the task of supervising health practices in this country. The decision authorized a few physicians in Vancouver to prescribe heroin to a selected number of clients, patients who have failed other treatment attempts to keep their addictive habits manageable. The doctors did not seek such authorization because they wish to promote drug use but because clinical practice and scientific evidence have shown that the provision of this opiate is beneficial in some cases.

    [IMGR=''white''][/IMGR]Your reported comments were that there are already safe treatments for heroin addiction, such as methadone, and that there is insufficient proof that heroin is a safe treatment for drug addicts. I find your statements puzzling, at best. There has been no sign that you or your government pay the least attention to scientific data in formulating drug policies. It would be helpful if you were to cite publicly which studies you have consulted, which ones support your position, or how the many that do not may be lacking in scientific acumen, method, or objectivity.

    For many years, I worked as a physician in Vancouver’s Downtown Eastside. I can personally attest that some people simply fail methadone treatment. It does very little for them. Their particular biochemistry does not respond to that synthetic opiate. They still need to keep using heroin. It’s just how it is. I trust you don’t like that. I don’t like it either. I wish it were otherwise, but what you or I may wish is not the issue. The issue is reality.

    Here is how a University of British Columbia professor who worked on a study published in the New England Journal of Medicine, probably the world’s most prestigious medical publication, put it: “Heroin assistance treatment has a very small, but very important, role in the addiction treatment system,” Dr. Eugenia Oviedo-Joekes told a Globe and Mail reporter recently. “It is not meant as a first-line treatment; it is meant to continue the care of people we cannot reach with what is available.” According to European studies, those people may be about 10 percent of the heroin-addicted clientele.

    In the absence of medically provided heroin in a safe environment, such unfortunate individuals will continue to seek illegal sources of drugs, potentially impure, and inject them under frequently unsafe circumstances. The resulting illness, overdose, and deaths are surely not outcomes you would desire.

    The documented benefits, according to Canadian and international studies, include:

    • less crime

    • better employment outcomes

    • improved physical and mental health, increased longevity

    • financial savings to the public purse

    • enhanced life satisfaction and social integration

    Given such findings, Minister, your opposition to this Health Canada permission, which you have moved to block, has little to do with insufficient proof. More to the point may be another statement of yours: “This decision is in direct opposition to the government’s antidrug policy.”

    There’s the rub, that policy. In response to the tragedy of addiction, your government has an antidrug stance. What you do not have is a pro-health strategy.

    The War on Drugs you and your cabinet mates favour has been proven, numerous times, to be an unrelieved disaster: it kills people, promotes illness, rewards drug trafficking on a massive international scale, ostracizes and marginalizes the most hurt and vulnerable among our population, destroys families, and incurs crippling financial costs. And it has utterly failed to curtail drug trafficking and drug use. In recent decades the purity of street drugs has improved while the price has decreased, despite all efforts to interdict their transmission and sale by draconian legal measures and despite greatly increased drug seizures.

    [IMGL=''white''][/IMGL]“The bottom line is that organized crime’s efforts to succeed in these markets has flourished, and the criminal justice system’s efforts to contain these markets have really been quite remarkably unsuccessful,” Dr. Evan Wood, Canada Research Chair in inner-city medicine at UBC, told Canadian Press on September 13. “By every metric, the war on drugs has failed.” As Werner Antweiler, a professor of economics at UBC, pointed out in that same article, “The drug problem has not become less, but more.”

    Three years ago, an experienced colleague and I were invited to Ottawa to address a Senate subcommittee then considering your government’s omnibus “tough on crime, tough on drugs” legislation, since enacted. The senators from your political party endured our testimony with unflinching politeness, listened impassively as we presented fact upon fact about the nature of addiction and the trauma-burdened life histories of addicted human beings, the flaws of drug-war approaches, the retrograde effects of criminalization, the necessity of harm-reduction measures such as the provision of opiates to confirmed addicts. Your senatorial party mates spoke afterwards as if they had not heard a word. Nor do you appear to hear any words that question what you believe. But what you believe personally should not matter when it comes to the health of human beings.

    “I want to be crystal clear,” your predecessor as health minister, Leona Aglukkaq, said last year. “I do not believe that politicians should pick and choose which drugs get approved.” Perhaps that is why you have replaced her. Nor does your British Columbia counterpart agree with you. “I know that the thought of using heroin as a treatment is scary for people,” B.C. health minister Terry Lake has said, “but I think we have to take the emotions out of it and let science inform the discussion.”

    There is that word again, science. Based on which, your invalidation of this Health Canada decision will have predictable effects: illness, death, suffering.

    I know that is not your intention. I’m sure in your heart you wish, as we all do, that addicted people would heal, that drugs would no longer blight the lives of so many. I’m convinced of that. But an objective regard for the facts leads me to this lamentable conclusion: whatever your intentions are, so long as you embrace policies that promote illness, you are in fact serving as Canada’s minister of disease.

    By Gabor Mate
    Photograph google img; Gabor Mate
    Oct 23 2013
    Straight News
  2. Hover
    I'm not sure I understand. Diamorphine in Canada is already used in hospice care. in fact restricted to that use. But in the article above someone mentions that using it would reduce demand for illegal heroin? Makes no sense, if someone is in good enough shape to seek out street heroin they are certainly not in hospice care. Am I to understand that this group wants diamorphine be dispensed to outpatients? Never gonna happen that's for sure, that drug is, like, Super-Dooper-Restricted-Schedule I, in Canada that means ultra-controlled. Cocaine is in that schedule.
To make a comment simply sign up and become a member!