Heroin-assisted treatment and politics-based medicine - Macleans.ca
 

Heroin-assisted treatment and politics-based medicine

‘Ms. Ambrose doesn’t have any medical education’


 

A lawyer for some of the patients in the SALOME study says he’ll consider options for a legal response to Rona Ambrose’s decision to block access to diacetylmorphine.

Scott Bernstein, a lawyer for the Pivot Legal Society, which is representing 22 SALOME patients as well as the B.C. Association of People on Methadone, said he will explore all legal options once the exact details of the new regulations are known. He said he is concerned by the fact the government can “close off” Health Canada’s ability to make decisions.

“Ms. Ambrose doesn’t have any medical education,” he said. “Taking this decision out of the hands of experts … and making a decision based on politics – is that how we want to approve medical care in this country?”

On that point, Mr. Bernstein has previously pointed to a letter written by Ms. Ambrose’s predecessor, Leona Aglukkaq, to provincial health ministers on the subject of Oxycontin. Heroin and oxycontin are perhaps not perfectly analogous, but the principles invoked by Ms. Aglukkaq do make for an interesting read now.

As Health Ministers, we have the tremendous responsibility of making decisions every day that have direct impact on the lives of Canadians from coast to coast to coast. These issues are often complex, with conflicting opinions on each side about what the right balance of individual responsibility and government action should be.

There is no basis in the Food and Drugs Act for the Minister of Health to withhold approval of a drug where the drug is otherwise considered safe and effective for its recommended use. The law does not permit approval to be withheld on the basis of misuse.

In terms of the prescription drug OxyContin, I have heard heartfelt pleas from doctors and patients who speak to the positive impact it has had in treating chronic pain.

And I have heard heartbreaking stories of abuse and addiction destroying the lives of individuals and families.

Both sides of the argument are compelling, and require a response from us as Health Ministers.

During our recent Health Ministers Meeting, the request was made for me to delay approvals of generic versions of OxyContin. At that time, I committed to relay any research you had related to this request on to Health Canada scientists for their consideration. Shortly after our meeting, my officials held a teleconference with your officials to review any research.

I want to be crystal clear: I do not believe that politicians should pick and choose which drugs get approved. While intentions may be noble in this circumstance, what stops future politicians from caving into public pressure and allowing unproven, unsafe drugs on the market once political pressure starts to mount?

A drug approval process based on politics is a recipe for disaster.

Meanwhile, here is a note Libby Davies posted to Facebook last night.

I see that the minister of health is at it again – denying critical treatment in the form of herion maintenance to chronic drug users, by changing the regs. They play politics with people’s lives. It was quite disgusting to see that the Cons used their political dogma on this, as a fund raising letter! How’s that for exploitation? To all the docs, researchers, activists, and fine people who actually try to help people, please know we support you. We will continue to stand up for compassion, and evidence based decisions.

Ms. Davies and Dany Morin have now raised the matter with Ms. Ambrose via Twitter and the NDP’s virtual QP.


 

Heroin-assisted treatment and politics-based medicine

  1. Well, all decisions by politicians are political by nature, but they should know when to leave stuff to the experts.

    This generally was not a problem before the current government.

    • How are a lawyer and 2 opposition MPs “experts” more so than the Health Minister?

      Do you not think it’s possible that MOST doctors that aren’t political activists think that prescribing heroin to heroin addicts is a BAD idea? You’ll note that Wherry’s been very careful in not making even the slightest attempt to show the other side of the story.

      I’m pretty sure my doctor wouldn’t give me a heroin prescription if I went in and asked for one tomorrow. He’d say that would be irresponsible and dangerous, and he’d be right.

      • Have you even read anything that’s been posted on this subject here in the last few days? Giving heroin to heroin addicts is counterintuitive, I know, but if you actually read what’s being presented, you might come to understand the logic of it.

        First off, you wouldn’t walk into your doctor’s office looking for a heroin prescription — not unless all other treatment methods have failed. And, based on what I’ve read here, that makes up about five per cent of those being treated (so, for the other 95 per cent, methadone and other treatments work, and we don’t have to take this step).

        Second, medicinal heroin is not the same as the stuff you get on the street. Equating the two is wrong. And, it’s effective. “The research, published in Thursday’s edition of the New England Journal of Medicine, shows that patients treated with injectable diacetylmorphine (the active ingredient in heroin) are 62 per cent more likely to remain in addiction treatment and 40 per cent less likely to take street drugs and commit crimes to support their habit than are those treated with oral methadone.” That’s good, right?

        Third, medicinal heroin might not work for you. But, given that you’ve exhausted all other means by which to kick the habit, you’re now down to the last option before incarceration or death. At that point, don’t you think it’s worth a roll of the dice? Or should we just write those folks off?

        • Am I the only one who finds the things being measured in this study disturbing? If addiction treatment consists of providing someone with the substance they are addicted to of course they are 62% more likely to remain in treatment. This doesn’t say anything as to whether or not they are more succesful breaking their habit, it just says they are staying in addiction treatment longer.

          As for the addicts being 40% less likely to take street drugs and commit crimes to support their habit. Which are they 40% less likely to do? If they are 40% likely to take street drugs that is expected because their habit is being provided by addictions treatment. Are they actually 40% less likely to commit crimes to support their habit or is that being inferred because they are 40% less likely to take street drugs?

          • This might help you out.

            http://www.theglobeandmail.com/life/health-and-fitness/health/conditions/use-heroin-to-treat-diehard-addicts-study/article1322072/

            We’re talking about people who have tried every other treatment program and have failed. These are folks who don’t respond to methadone. And, as the study shows, not everybody responds to this method, either. But, it’s their last hope. I can’t understand the obstinance, why it isn’t at least worth a try. We either try diacetylmorphine, let them die, or pay for them to be in jail. Seems like a no-brainer to me.

          • “Maybe” if we just cut them a check for a million dollars they’d quit too. Why don’t we give that a try?

            I mean “science” has indicated that people have a strong compulsion to do things that will result in a large sum of money coming their way.

          • No, Rick, that’s nuts.

            Anyway, I’ve changed my mind. I’m with you on this one. We should throw them in jail or let ’em die.

          • In jail at least they’d be getting treatment and not be a danger to the rest of society.

          • How much is incarceration going to cost, Rick? I bet it’s a helluva lot more than diacetylmorphine treatment. And, remember, that addict has already tried every other treatment available outside of prison, and they haven’t worked. They won’t be getting anything different inside the prison. It’s just going to cost us more to provide something that doesn’t work.

            But those are your choices, Rick: the patient goes to jail, or the patient dies — all because you don’t think it’s right that we take a chance with diacetylmorphine. Or, to be more specific, all because your CPC wants to use the slogan ‘the NDP and Liberals want to give heroin to heroin addicts!’ to drum up a few bucks for the party.

          • You say many words. Make rick brain hurt. Rick know heroin bad.

          • Who cares how much incarceration costs? Cost isn’t really an issue when it comes to public safety. You wouldn’t suggest letting murderers walk the streets just because it costs money to lock them up, would you?

          • Nice strawman.

            I don’t have any problem paying for someone’s incarceration if they are a threat to society. However, I do have a problem paying for someone’s incarceration when another, more compassionate, more effective, less expensive treatment method might be available — one where society is protected AND the patient might recover. Clearly, however, you’re more comfortable with the less compassionate, less effective and more expensive option that writes off the patient because, well, that slogan is just too important to your party to suggest otherwise.

            Unless you can provide me with something to suggest that diacetylmorphine treatment is not effective, my debate with you is over.

          • R.I.P Fiscal Conservatism. I’m shedding a tear for a time when real costs were considered in the equation.

          • Who cares how much incarceration costs? Cost isn’t really an issue when it comes to public safety.

            Even by your standards, that is an incredibly stupid thing to say. The PMO should really review it’s roster of internet trolls and take you out of the lineup.

            How’s that iDrinkInTheMorning.com website coming along Rick Omen? The link that appears with a click on your name?

          • In fact on the whole I bet many have done some stints in prison and found it didin’t work and they didn’t receive the treatment they needed.

          • Great idea. TB and AIDS could be treated and society protected with the same incarceration method.

          • Don’t give them any ideas…

          • Rick, the real issue here is in how YOU look at an addiction. Those of us in medicine and many others look at it as an illness that requires treatment and as such, we would prefer to treat someone rather than incarcerate them. Now, the reality is that there are many, many people with addictions to heroin that are already receiving treatment in the form of methadone, which let’s face it, is a kind of synthetic morphine. Many of these people never successfully stop craving heroin and they continue receiving methadone for years because it keeps them out of jail. About 5% of heroin addicts do not respond to methadone treatments or other alternatives. For them, the dicytlmorphine injection is a successful treatment. You can chose to deny it to that 5% and look after them in prison, time after time or you can just face it that heroin addiction is a horrendous illness that destroys people and there is no magic bullet to treat it. Until we find one, we have to make due with what are the most humane and financially responsible treatments available to allow these people to live somewhat productive lives.
            Despite Emily’s flippant attitude, every country including the UK has struggled with this issue. They have come to the conclusion that incarceration is not a financially viable nor humane way to deal with problems of addiction.

          • Thanks for the link, I’m still not sure that anything in that study suggests this treatment can successfully get people off heroine.

            The increase in people who stayed in treatment for more than 12 months, the reduction in money spent on street heroine, the reduction in days of the month using street heroine can all be attributed to the fact that addicts preferred getting free heroine over paying for street heroine.

            I would also like to point out that reading what the actual study said has confirmed that the assertion that “40 per cent less likely to take street drugs and commit crimes to support their habit than are those treated with oral methadone” is absolutely NOT what the study said.

            The study said that there was a 40% reduction in the use of street heroine and Dr. Schechter noted that addicts tend to raise that money through illicit activities such as theft, selling drugs and sex work, so those activities presumably decreased. This does not mean there was a 40% reduction in street crimes to support their habit as is implied by the Globe article.

          • I certainly understand your reluctance to embrace this kind of treatment and you are right, this treatment doesn’t promise to successfully get people off of heroin. In fact, what is hoped is that people will ‘mature out of using the drug’.
            I think the problem is that most people don’t realize that there are some people who are addicted to heroin who are never going to get off of the drug successfully without substituting for something else…either methadone or this dicytlmorphine. For the 5% that the methadone doesn’t work as a substitute for, the dicytlmorphine is proving successful. Otherwise, you are looking at incarcerating these people because they are so stubbornly addicted that they will ultimately end up in prison, year after year. Now, what would you rather pay…1/3 of the cost of incarcerating them to provide dicytlmorphine treatment or the full cost of incarcerating them. That is the question it came down to in Britain. No moral questions but all dollars and cents…all reality.

      • “Do you not think it’s possible that MOST doctors that aren’t political
        activists think that prescribing heroin to heroin addicts is a BAD idea?”

        When determining whether Doctors believe prescribing heroin is appropriate in some circumstances we must first determine whether the doctor is a political activist or not. This is done by asking “is prescribing heroin appropriate is some circumstances?” If the doctor answers “yes” he/she is a political activist.

        “I’m pretty sure my doctor wouldn’t give me a heroin prescription if I went in and asked for one tomorrow.”

        Really? I’m shocked. Is that usually what happens to you when you tell you doctor what’s wrong with you and how to treat it?

  2. “Ms. Ambrose doesn’t have any medical education,”……nope but Cons never let a little thing like that get in the way of their religious-right govt

    • Scott Bernstein, Libby Davies, or Dany Morin have zero medical education as well, but their opinions are perfectly valid in the same context? Hypocrite!

      • They’re backing science Rick….gawd, you’re slipping!

        • They’re backing the science that they choose to because it fits their politics. You think there isn’t any science out there that indicates that doing heroin is a bad thing?!?!

          It’s really becoming disgusting how left-wing loons seem to think that they’re the ones who dictate what is “science” and what isn’t. You clearly don’t understand the meaning of the word.

          • “The research, published in Thursday’s edition of the New England Journal of Medicine, shows that patients treated with injectable diacetylmorphine (the active ingredient in heroin) are 62 per cent more likely to remain in addiction treatment and 40 per cent less likely to take street drugs and commit crimes to support their habit than are those treated with oral methadone.”

            Brought to you by the left-wing loons at the New England Journal of Medicine.

          • So you’re another one of these Liberals who believes a single study results in an irrefutable fact? You think that Wherry isn’t cherry picking the studies that have the results he wants, while ignoring the ones that don’t?

          • Show me the studies refuting what has been presented, then, and I’ll change my mind. Otherwise, you’re asking me to go with YOUR gut, rather than people who have actually looked at the problem, engaged in some study and do, y’know, know what they’re talking about.

          • You need to see a study to believe that doing heroin is bad for anyone’s health?

          • So, when you said above that “they’re backing the science they choose because it fits their politics”, the science they didn’t choose was NotRick’s super-sciencey “heroin is bad” proclamation?

          • It’s not rocket science to realize that heroin is bad for your health. If you don’t believe me, do your own study.

          • Uh geez Rick it’s a bit embarrassing to have to ask you this, but do you
            realize the topic here is the use of heroin to ultimately
            stop the use of it?

          • When will the government start giving me free cigarettes so I can quit smoking? I can’t wait for that day to come!

          • Yes Rick. But these people are already using; we’re not talking about giving it to people looking for a new drug of choice.

            This is minimizing the risk – to the user and to society.

          • Get serious Rick, you’re not at a brainstorming session at the PMO.

          • Sure it is. And, counterintuitively, it can be used to get people off the drug, as the studies provided have shown. Can you tell me that it won’t work? Have you done any studies, or can you point to anything specific that would suggest that the findings in the study I cited have it wrong?

            Further, we’re talking about an end-of-the-line treatment. These people have tried everything else, and it hasn’t worked. So, it’s either we pay for them to be in jail, or they die. You think those are the superior options?

          • Actually, I don’t believe anyone is saying that the injections of diacetylmorphine will result in getting people off of heroin in the short term anyway (by short term, we are talking years). When you provided those stats from the New England Journal of Medicine, what you are missing is that these therapies are very very long-term. The people treated with the dictylmorphine are “62 percent less likely to take street drugs and commit crimes”….while receiving the injections….”than those treated with oral methadone”. Again, they are talking about a very small group of “5% of those addicted to heroin that do not respond to methadone and other alternative treatments” in this comparison. No one is suggesting that every heroin addict be treated with dictylmorphine injections because it is not necessary and it would be very difficult to maneuver. Some people never get off of the treatment, methadone or alternatives. With methadone they can take it in juice in a treatment setting monitored by the neighborhood pharmacist. The dictylmorphine is an injection and a highly controlled substance. Patients tend not to like injections and delivering the medication causes increased difficulties.

          • I get that. All I’m suggesting (in the face of folks like rick who are eager to dismiss it, or worse, use it as the basis of partisan attacks to benefit the CPC) is that it’s a tool in the toolbox. It’s not a panacea, not even close.

          • Well Rick doesn’t see addiction as an illness. He also doesn’t look at the risk/benefit issue surrounding this sort of approach to treatment. It is fine to make a stand on exalted ethics of what should happen in an ideal world but in this “real world” we have to deal with what is and not with what Rick wishes it was.

          • You hit the nail on the head. Y’know, I get why harm reduction strategies make people uncomfortable. I’m not totally comfortable either. But, if the goal is to keep people alive, hopefully long enough for them to recover, then I can get past my discomfort. I can understand if others can’t. What galls me is that this is being used as a CPC attack. It’s repugnant.

          • Hey the CPC is a political strategy machine. They will make them take them take them to court just like they did the injection site and the government will lose. The patients will get treatment and some will celebrate and others will grumble. For everyone at CPC headquarters it is a win because their base is happy that they didn’t capitulate and the guys that knew it was right to give the treatment will be happy because the patients got the treatment. It is the same thing with the abortions for child brides overseas. They will fund them for those in danger of losing their lives and keep everyone happy because a physician will decide that every child bride or victim of rape is in danger of losing her life if she carries the fetus. You might not like it but it is how they play the game.

          • Crazies with an agenda, clearly.

          • Mmm no, science is pretty much science Rick…and they know how well this method works.

          • So you believe that all scientists think that doctors should be prescribing heroin? Just like all scientists believe in global warming?

            You’re ignorance used to be shocking, now it’s just annoying.

          • Done for years in the UK Rick….gawd, pull up your sox

          • Oh well, they’ve done it in the UK, thus it must be “science”. I guess we’ve all been doing it wrong by calling our homes “houses” instead of “flats” all these years. After all, Emily’s definition of “science” says so!

          • Heh….noop yer sox are still down around yer ankles…science is science everywhere in the world luv.

          • **Shilling in progress**

          • So you think the doctors treating heroin addiction think taking heroin is a good thing? You need to stop and think about this a little more it seems. You are chasing your tail at this point.

      • So – consulting with experts in the field bad, stirring up ignorant populist sentiment for fundraising purposes good.