Vancouver prescription heroin users wage court battle with the feds

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      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.”

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      Mar 20, 2014 at 11:22am

      How stupid. Heroin users are going to sue the government to secure heroin "as a legal means to manage addiction". Why would you want to "manage" your addiction. Why wouldn't you want to rid yourself of your addiction????? Maybe they just want heroin!!!!! The whole concept of using drugs to stop using drugs is RIDICULOUS. And don't tell me I don't know what I'm talking about. I was addicted to cocaine for over 10 years. If you had told me that someone wanted to give me cocaine to "manage" my cocaine addiction, that person would have been my new best friend - until they didn't give me any more cocaine. That seems like exactly what is happening here. And people wonder why the addiction problem in this city just keeps growing by leaps and bounds. Because people like BC
      Coastal health(your tax funded health agency) think ideas like this are good. I call it surrender.


      Mar 20, 2014 at 1:03pm

      Sorry, I missed this gem "with your heroin habit supported, you could think about bettering your life. It gives you a chance to think and get your head back together." There's a lot wrong with this statement. First, why should the government (taxpayer's) support anyone's heroin habit? They don't support my Big Mac habit. Second, If you want to better your life - DON'T DO HEROIN! Third, heroin doesn't "give you a chance to think". Seems the whole point of doing heroin is to not think about how your life presently is. But thinking about your HABIT might help. Doing something about your heroin habit - that is NOT DOING HEROIN - will definitely help. Fourth, the idea that doing heroin will help you "get your head back together" is just lunacy. Doing heroin is one of the things that helped tear your head apart to begin with. And before I hear the cries of me not being compassionate, ask yourselves this question. Is helping anyone do heroin really compassion??? Seems like a lot of people are just trying to rationalize their behavior. It's easy to say it's ok when you don't really have a connection with an addict. But if it was your child or family member, would you really think that doing heroin is the way to stop doing heroin???


      Mar 20, 2014 at 1:12pm

      From cuz's second comment: "Don't do heroin."

      Problem solved. I can't believe that nobody has ever thought of this. Call Washington, the war on drugs us over.


      Mar 24, 2014 at 9:33pm

      Anyone that thinks they aren't already paying for someone's heroin habit is just in denial.I have spent over 12 years incarcerated in the Provinces jails and penitentiaries and several more years involved with the police and the courts.Part of the price of everything you buy comes from higher prices to make up for theft.Most break ins and armed robberies are committed by addicts.I would gladly pay for my heroin if the drug war and prohibition didn't have the price set as high as it is.If I could go online and contact an Afghan heroin dealer and get a kilo I would.Even now that I have been diagnosed with a damaged lumbar spine and need heavy pain medication and even though I made a deal to forgo surgery if maintained on Dilaudid.I have been forced through coercion,lies,manipulation and undue interference to try to manage the pain with methadone.I have been on methadone so many times without success for addiction and now that I have a legitimate reason to be prescribed heroin.The system seems more determined than ever to see to it that I don't get the necessary medication.The ideology that has been torturing me for almost six years is the same ideology that is trying to deny these addicts their heroin.The need for heroin is every bit as medically valid as the need for insulin,dilantin or aids drugs.The 100 year experiment with drug prohibition has been an undeniable tragedy.There is no difference between the person that uses cannabis several times daily for pain and the heroin addict.Both are using a plant based substance to manage symptoms that make life unbearable.Neither substance harms the body in any way.