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.”