Gabor Maté: A letter to Rona Ambrose, Canada’s "minister of disease"?

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      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.

      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.

      “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.



      Paula Pothier

      Oct 24, 2013 at 7:15am

      Deeply angers and saddens me to see how much clout and decision-making power these political ignoramuses (that are elected by "the people") are allowed to wield. Ambrose's unwillingness to listen to scientific evidence and her resulting head-in-the-sand policy that has such dire consequences for so many people on so many levels, is sickening. It saddens me further to realize that even if she read Dr Maté's book: In the Realm of Hungry Ghosts, she probably still wouldn't get it...such is the disease of political power gone bad. Perhaps the only thing that would change her mind is having a direct and lived experience being and working with people with addiction. Too bad we can't make 'job shadows' (read 'reality checks') mandatory for these myopic public officials.

      2x2 project

      Oct 24, 2013 at 5:14pm

      Pls read our open letter to Ms. Ambrose in support of heroin addiction treatment with DAM
      Pls RT our open letter to Ambrose for #heroin #addiction #therapy


      Oct 24, 2013 at 9:31pm

      "Hungry Ghosts" is such a first rate book that any politician at any level would benefit from reading it, esp. a federal minister of health. But one suspects the current government has other issues to deal with at the moment, sadly of their own making. Which is the real insult to Canadian taxpayers isn't it? Instead of doing their jobs, because of incompetence and avarice, they're spending their time, paid for by us, in what looks a lot like trying to save their jobs.


      Oct 24, 2013 at 10:10pm

      Bravo Dr. Mate! You tell it like it is.


      Oct 24, 2013 at 10:10pm

      Superb letter


      Oct 25, 2013 at 3:35am

      Before you can comment on failed enforcement tactics I think you should post how many criminal drug investigations you have personally been part of. I have no issues with a doctor prescribing heroin to a patient if it is going to show positive manageable results. I say this because I am not a doctor and don't have the same training as you. Just a you are not a law enforcement professional and don't have the same training as I do when it comes to the so called war on drugs. There are many reasons that the drug trade in this country has skyrocketed and many of those have to do with the complete lack of commitment to enforce the law by our justice system. As to the quality and availability of drugs, that speaks directly to innovation and lower cost of production on the part of the producers and traffickers of these drugs. I support your comments on politicians keeping quiet on medical treatments but I also say doctors shouldn't have a say in how law enforcement gets done either. You heal em I'll protect em.


      Oct 28, 2013 at 11:49am

      Sanity ends where ideology begins


      Oct 31, 2013 at 1:21pm

      "There has been no sign that you or your government pay the least attention to scientific data in formulating drug policies." As far as I can tell the Harper government doesn't pay the least attention to scientific data in formulating ANY policy that would benefit from being based upon scientific data. So this latest move is deeply disappointing, but not surprising.

      James House

      Nov 7, 2013 at 1:52pm

      It is a great letter and it speaks to virtually every aspect of the problem with what is known today in terms of the reality of treatment for heroin addicts.

      Unfortunately Dr Mate is writing to a drone of the Harper PC's. He may as well be writing Santa, at least he'd get a reply.


      Nov 7, 2013 at 4:44pm