Another Vancouver-based harm-reduction initiative is entering the courts in a battle with the federal government.
On March 25, Providence Health Care and five long-time opiate users will appear in B.C. Supreme Court as plaintiffs in an effort to secure diacetylmorphine, or prescription heroin, as a legal means of managing addiction.
David Byres, vice-president of acute clinical programs at Providence—which operates St. Paul’s and Mount Saint Joseph hospitals in Vancouver—told the Georgia Straight that the case concerns past and present participants in the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), which is under way at Providence Crosstown Clinic in the Downtown Eastside.
In a similar study called NAOMI (North American Opiate Medication Initiative), conducted from 2005 to 2008, Byres said, health professionals observed that in certain cases, heroin-assisted therapy proved more effective than methadone in improving the wellbeing of long-time opiate addicts. (Those results were published in the New England Journal of Medicine in 2009 and are supported by similar academic findings in Denmark, Germany, Switzerland, and the United Kingdom.)
Vancouver doctors previously secured the necessary permissions under the federal Special Access Programme to prescribe heroin to patients who had exited SALOME. But in October 2013, Health Minister Rona Ambrose amended regulations to close what she described as a “loophole”, barring clinicians from administering drugs such as heroin, cocaine, and ecstasy (MDMA).
Byres explained that Providence has therefore launched a constitutional challenge and, while that moves through the courts, is asking for an injunction that would allow doctors to prescribe diacetylmorphine where it’s found to be the best course of action.
“A constitutional challenge has been filed based on the belief that the participants’ right to access evidence-based treatment under the [Canadian] Charter [of Rights and Freedoms] has been impeded,” he said.
Kevin Thompson, a peer supervisor at Insite—North America’s only legal supervised-injection facility—is a former participant of NAOMI and SALOME who stands to benefit from a Providence win in the courts. Walking down East Hastings Street, he told the Straight that just as Insite gave people a safe place to use drugs and let them move out of the alleys, diacetylmorphine could go the next step, sparing addicts the dangers of buying street drugs.
“With NAOMI and SALOME, waking up, you knew you were going to be getting your fix three times a day,” he explained. “You didn’t have to worry about waking up sick.…And then with your heroin habit supported, you could start thinking about bettering your life. It gives you a chance to think and get your head back together.”
For him, Thompson continued, that meant moving off the streets into one of the Portland Hotel Society’s modest rooms, getting a job, and finding a girlfriend.
“That’s why I’m behind SALOME,” he said. “You get up and you know you can go three times a day. I went at 8, 12, and 5. So all I had to do was make it to those times and my life was great.”
Making time to escape addiction
Doug King is a lawyer with Pivot Legal Society who is representing Providence and its patients alongside Joseph Arvay, the lawyer who represented Insite in its 2011 victory in the Supreme Court of Canada. King told the Straight that heroin maintenance isn’t recommended for every opiate addict but that when methadone and other traditional therapies have failed, it should be an option.
“For them, addiction is not really about getting high anymore,” he said. King explained that by providing severe addicts with a regulated supply of heroin, you remove the incentive to engage in criminal activities such as theft and prostitution. In turn, he continued, you also free up individuals’ time so they can pursue more productive endeavours, such as improving living conditions and keeping a job.
Affidavits drafted by the five opiate users participating in the case emphasize the struggles involved in maintaining the steady supply of drugs required by heavy addictions. The documents explain how heroin administered on a prescribed basis alleviates the harm users inflict on themselves and society.
“I spent my money on food and vitamins rather than drugs, and I became healthier,” Charles English wrote. “While on the study, I exercised regularly and took care of myself. I did not commit any crime to support my drug habit. I took showers, wore clean clothes, and was a functional member of society.”
Another affidavit, attributed to Deborah Bartosch, describes SALOME as “the best thing that ever happened to me”.
“My life was freed up to do other things, including taking care of myself and producing art,” it reads. “I felt less stress and anxiety about finding drugs and was able to focus on my health and well-being.”
In a telephone interview, Dr. Gabor Maté, author of In the Realm of Hungry Ghosts: Close Encounters With Addiction, told the Straight that the ultimate goal remains getting everybody off drugs. But for some people—especially vulnerable users, many of whom were abused or otherwise traumatized as children—that might not be possible.
“The drug addict is a particular case of somebody who is trying to soothe themselves from the outside because of internal distress and disturbed brain circuits,” he explained. “It has to do with many different factors, all of which are related to early life experiences, and particularly trauma when the brain was being shaped.”
Maté emphasized that there is a science behind drug abuse, which means that addicts should be treated as patients instead of criminals.
The fight with Ottawa continues
Health Canada declined to make a representative available for an interview.
Libby Davies, opposition health critic and NDP MP for Vancouver East, told the Straight that B.C. has always fought with the federal government on harm reduction. (B.C. Health Minister Terry Lake has stated that he supports SALOME and disagrees with Health Canada on its decision to restrict access to diacetylmorphine.)
“At the beginning, the Liberal government of the day was not eager about giving Insite the exemption [from the Controlled Drugs and Substances Act],” Davies recalled in a telephone interview. “All of this did not come from Ottawa, believe me. This came from real experience in Vancouver and a real struggle about how to appropriately, humanly, and compassionately respond to a crisis of drug overdoses and people dying.”
Davies said the federal Liberals largely came around but that Prime Minister Stephen Harper and the Conservatives continue to oppose harm reduction on ideological grounds. She noted that although the debate is largely settled out west, the fight with Ottawa continues.
Former Vancouver mayor Sam Sullivan, who took a lead role in initial fundraising efforts for SALOME, described heroin maintenance as a potential next step on the path Vancouver has taken on harm reduction. He traced SALOME’s roots back to the Downtown Eastside in the mid-1990s, when about 200 people a year were dying of drug overdoses.
“Vancouver was one of the first cities in the world doing these things,” Sullivan said. “We were celebrated around the world for methadone and leading the way in terms of needle exchanges and things like that.”
Sullivan emphasized that the science indicates prescription heroin could be a “very important” component of health-care policies in Vancouver. “It’s a different approach,” he added. “A much more intelligent approach to the problem of substance misuse.”