Health Canada's prescription heroin ban issued on thin ground

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      In October 2013, Health Canada made a regulation change that banned B.C. doctors from prescribing heroin to a small group of addicts.

      The federal department did that after consulting only one scientific report on the matter, according to documents released in response to a freedom-of-information request. Furthermore, that one expert’s opinion is that prescription heroin, or diacetylmorphine, should remain an available treatment option.

      The document was prepared for Health Canada by Dr. Michael Lester, an expert in opioid-dependence treatment and an assistant professor at the University of Toronto. It describes prescription heroin as a “pragmatic approach for people who do not significantly reduce their intravenous diacetylmorphine use despite an adequate trial of Methadone Maintenance”.

      Regardless, Health Minister Rona Ambrose removed diacetylmorphine from the federal Special Access Program (SAP), closing what she described as a “loophole” and barring clinicians from administering the drug.

      In March 2014, the Straight met Ambrose at an unrelated speaking engagement in Vancouver and asked her how Health Canada made its decision.

      “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 of their accounts.”

      The Straight spent the next seven months requesting documentation, but none came until now.

      Four months overdue, Health Canada finally delivered a response to a freedom-of-information request that asked for “all studies and/or expert opinions consulted by Health Canada” related to diacetylmorphine’s removal from the SAP.

      Aside from emails mostly discussing how to answer questions from media, the only document included in that FOI response package is the report by Lester.

      “There is a minority (estimated to be 10 to 20 percent) of opioid dependent patients who have failed multiple attempts at treatment with Methadone Maintenance and continue to use illicit intravenous opioids,” it states. “There currently exists in Canada no effective ‘next step’ in treatment for these individuals.”

      On the phone from Toronto, Lester told the Straight that he cannot comment on the report he authored. “Health Canada doesn’t let me talk about that study,” he explained. “They say it is property of the Crown and any questions about it should be referred to them.”

      Health Canada did not respond to a request for an interview.

      Expressing his personal opinions on the topic of heroin-assisted treatment, Lester called it “a reasonable option”.

      “The science behind it has been reproduced over and over again in Europe and in Vancouver,” he noted. “It is beneficial to a small group of people who are treatment-resistant to more conventional treatments for opioid dependency.”

      An appendix to Lester’s report summarizes 15 studies on the subject of opioid-dependence treatment. Only one even comes close to taking a position similar to Health Canada’s; it suggests that another drug, called hydromorphone, may be a better option than diacetylmorphine “due to reduced stigma and less regulatory barriers”.

      Also included in the FOI-response package is a summary of Lester’s report drafted by a Health Canada employee named Barbara Sabourin. It states that for the group of severely addicted patients studied, diacetylmorphine maintenance not only improved health outcomes but was also found to increase social functioning and reduce criminal activity.

      Ambrose’s decision later became the subject of a legal challenge by Providence Health Care and five long-time opiate users. In May 2014, the B.C. Supreme Court granted an injunction that lets doctors give prescription heroin to select patients. Before the end of the year, members of a small group of Vancouver addicts are expected to become the first Canadian recipients of prescription heroin outside of a clinical study.

      In October 2013, B.C. health minister Terry Lake expressed his support for heroin-assisted treatment.

      “We have to think outside of the box sometimes,” he said. “I know that the thought of using heroin as a treatment is scary, but I think we have to take the emotion out of it and let science inform the discussion.”

      Comments

      6 Comments

      Dianna

      Oct 10, 2014 at 7:35am

      Long term addiction treatment is a serious cause. But it would really be nice if Minister Ambrose concentrated on the core CAUSE of this addiction. While the Federal Govt and Health Canada are deciding how to treat heroin addicts, their Doctors are actively making more. Doctors regularly prescribe HEROIN for short term pain like tooth extractions, gall bladder laparoscopies, and other small procedures. Why ever introduce that warm fuzzy feeling to anybody? It only takes one time to really LIKE the way Opioids feel. Why not BE REAL and curb this early heroin introduction by your Doctors?

      Oh ... right ... Pharma has to make their money right?

      Your job Minister Ambrose is to keep Canadians healthy and safe, not to keep pharmaceutical use climbing.

      Maybe it's time to DEVELOP NEW PAIN KILLERS THAT ARE NOT ADDICTIVE!!!

      KUDRA

      Oct 10, 2014 at 9:27am

      D,
      I feel you are hitting the nails's head!
      "Hey Rona!,
      D has a good point Eh'
      But that would bugger Doc "Slide'n Scale Bonuses"!
      Based on how much of what bigpharma Co is pay'n that week!
      Just care'n about the almighty buck Eh! You'll see in 15!
      Rona, LICKME!"

      Cate

      Oct 10, 2014 at 10:20am

      Diana, most people don't become addicts because of pain medication prescribed. Addiction is a lot more complex.

      This decision is just another example of a small minded twat letting her prejudice get in the way of the facts.

      Ambrose

      Oct 10, 2014 at 10:49am

      What does she actually know about anything beyond politics?

      Hermesacat

      Oct 10, 2014 at 12:35pm

      Harper's gang of hypocritical "moralists" lost the Supreme Court battle over safe injection sites (though they continue to try to erect roadblocks against new ones opening via "clever," sleazy legislation). Tories lost on safe injection as the medical literature all pointed to saved lives & reduced disease spread. As medical studies are overwhelmingly onside with heroin maintenance too for some addicts, hopefully the Supreme Court will similarly uphold lower court rulings allowing heroin maintenance programs. It's appalling we have a federal gov't that must be dragged kicking & screaming by the SCC into the 21st century & to rational, responsible, constitution-respecting drugs policies.

      Dustin J.

      Oct 14, 2014 at 1:21am

      I love the comment at the end of the article that states "maybe we should allow science to dictate the findings instead of emotion" not verbatim of course. That is an obvious, yet mind blowing thought. If it creates a better outcome, it makes sense. Obviously decriminalizing all illigal drugs would solve the majority of these types of issues but since this isn't truly based on the fundamental addictions in human beings, I think we should take what we can get.