‘No evidence,’ Minister Ambrose?

The Health Minister on heroin-assisted treatment

by Aaron Wherry

In an interview with the CBC yesterday, Health Minister Rona Ambrose said there was “no evidence” to suggest heroin-assisted treatment was a safe and effective option. Actually, she used variations on the phrase seven times in the space of seven minutes.

There is no evidence at this point that heroin—giving heroin to heroin addicts—is any way an effective treatment…

As I said, there is no evidence that this is an effective, safe treatment…

There is no evidence at this time, no clinical evidence…

There is no clear evidence to suggest that this a safe treatment and it’s not a good idea for Health Canada, for Health Canada, to be supporting giving heroin to heroin addicts when there’s no scientific evidence that this is a safe treatment…

There is no evidence at this time…

Here is a 176-page report that was released last year by the European Monitoring Centre for Drugs and Drug Addiction. It was prepared by researchers with the National Addiction Centre at King’s College in England. In addition to considering the history and context around heroin-assisted treatment, the authors review the results of six randomized controlled trials, conducted in Switzerland, the Netherlands, Spain, Germany, England and Canada respectively.

Those studies are detailed at length in chapter three of the report, but here is what is reported under the heading “scientific evidence base” in the executive summary.

Over the past 15 years, six RCTs have been conducted involving more than 1 500 patients, and they provide strong evidence, both individually and collectively, in support of the efficacy of treatment with fully supervised self-administered injectable heroin, when compared with oral MMT, for long-term refractory heroin-dependent individuals. These have been conducted in six countries: Switzerland (Perneger et al., 1998); the Netherlands (van den Brink et al., 2003); Spain (March et al., 2006); Germany (Haasen et al., 2007), Canada (Oviedo-Joekes et al., 2009) and England (Strang et al., 2010).

Across the trials, major reductions in the continued use of ‘street’ heroin occurred in those receiving SIH compared with control groups (most often receiving active MMT). These reductions occasionally included complete cessation of ‘street’ heroin use, although more frequently there was continued but reduced irregular use of ‘street’ heroin, at least through the trial period (ranging from 6 to 12 months). Reductions also occurred, but to a lesser extent, with the use of a range of other drugs, such as cocaine and alcohol. However, the difference between reductions in the SIH group and the various control groups was not as great (compared with major reductions in the use of ‘street’ heroin).

Patients receiving SIH treatment achieved gains in physical and mental health, as well as social functioning, although improvements in those receiving SIH were not consistently or significantly superior to the control group across all trials, particularly in relation to psychosocial functioning.

Reductions in the criminal activity of SIH patients were evident and were substantially greater when compared with patients under control conditions. Retention in treatment varied substantially across the trials. The available evidence suggests added value of SIH alongside supplementary doses of methadone for long-term treatment-refractory opioid users.

Furthermore, efficacy of heroin provision as a treatment modality on several outcomes (retention, mortality) was corroborated by a systematic review conducted by the Cochrane Group. Although the inclusion criteria of studies in the latter review were stricter from a methodological point of view, converging conclusions on the efficacy of SIH further strengthens the current evidence of this. However, it is important to note that more serious adverse events have been reported to occur in patients receiving SIH than oral methadone. This suggests that SIH may be less safe and therefore require more resources and clinical attention in order to manage greater safety issues.

Finally, countries that have conducted longer term (up to six years) follow-up studies have seen a high retention in SIH (55 % at two years and 40 % at six years), with patients sustaining gains in reduced ‘street’ heroin use and marked improvements in social functioning (e.g. stable housing, drug-free social contacts and increased rate of employment).

The results of the Canadian study were published three years ago. Heroin-assisted treatment has been officially adopted in Switzerland, Germany, Denmark and the Netherlands.

After her last declaration that no evidence exists, Ms. Ambrose said heroin-assisted treatment was not a “proven” treatment. “We are focused on using effective treatments and supporting effective treatments that are proven effective and safe for people that are suffering from addictions,” she explained. That at least raises the possibility of further discussion here. Has Ms. Ambrose reviewed the evidence? Is she familiar with the experiences in Switzerland, Germany, Denmark and the Netherlands? Is she open to the possibility that heroin-assisted treatment could be proven to be safe and effective? At what point would she consider the treatment to have been proven effective and safe? And will it be her or officials with Health Canada who make that judgment?

Meanwhile, British Columbia’s Health Minister, Terry Lake, disagrees with Ms. Ambrose.

“We’re reluctant to close the door on innovation and creativity when it comes to tackling these very challenging problems. We have to think out of the box sometimes,” he said at a Toronto hotel after the health ministers’ meeting. “I know that the thought of using heroin as a treatment is scary for people, but I think we have to take the emotions out of it and let science inform the discussion. And in this case, I believe this was an exceptional circumstance, compassionate use of a medication to help people transition, and provides information as to treatments that may in fact prove better than alternatives for some people.”

… “I would encourage the use of science and not limit the ability of research to explore opportunities that might seem taboo but at the same time provide real help for people that are in a terrible situation,” he said.

See previously: The politics of the heroin addict, Heroin-assisted treatment and politics-based medicine and Q&A: Dr. Perry Kendall on heroin-assisted treatment




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‘No evidence,’ Minister Ambrose?

  1. Wait a minute…. are you saying Rona Ambrose is being wilfully ignorant?

    • Not at all. May I paraphrase Ms Ambrose’s response to her critics?

      La la la … I can’t hear you!

    • No…I believe the terms like being deceptive, practicing deceit, indulging in a fabrication, uttering a fiction, or telling a tall tale may be more accurate. Or, to use a more colloquial expression, she’s lying through her teeth.

    • Hey, commenters here seem too quick to blame hapless Rona Ambrose. Afterall, it’s not as if her lies & irrationality are her OWN. To be Minister in name she’s compelled to act as a stooge for the PMO. “Her” position on the issue & “her” opinions aren’t necessarily hers at all. The PMO has assigned her a position & has fed her talking points she’s dutifully regurgitating to the media now.
      Poor Rona, it’s such a degraded lot in life to be stuck in a career as a dutiful stooge for Harper’s PMO, not allowed to demonstrate any rational thought or opinion of ones own. Quit that pathetic gig, Rona, & get a life.

      • The Hounourable Rona Ambrose is a Bobblehead in-training.

        With practice, she will soon take the place of Bev Oda.

    • No, she is just plain ignorant

  2. Her minds made up, don’t confuse it with facts. It’s all about keeping the mouthbreathers happy. Conservatives don’t care who else gets hurt.

  3. Come on, folks – this is Rona Ambrose, for crying out loud. If it was spelled “hairoin,” she’d be all over it.

  4. To be fair that’s an awfully big study, full of big words un all, for Ambrose to read all the way to the end.

    • I usually agree with you kcm but in this case voted thumbs down, because the real tragedy here is that Rona *is* a very smart person. She’s smart enough to know that there is plenty of evidence out there and that she’s lying when she says there is not. She wouldn’t be the first politician of course to have this said, but how does her conscience deal with knowing she’s lying?

      • Oh i agree with you Derek, she’s smart enough to know better. I was just mocking. It’s pretty sad to see an otherwise intelligent human being bow the knee before the little god of ideological correctness.

        • I would not even say it’s ideological. ideologues aren’t necesarily dumb they just assume certain principles and view every situation through those principles even when it produces poor or absurd results.

          Here it’s more of “here’s a transparent lie we can tell people and maybe some will believe it and fork over money.” If I was a CPC supporter and thought my party thought it could reel me in on this, I’d be insulted and dismayed.

          • I suspect it’s even more banal that that.

            When you have a leader who operates as though he’s the CEO of a government, rather than the Prime Minister of a nation, that mindset seeps down, and the people who thrive within it are the ones who are most willing to submit to the culture of obedience.

            There’s very little room for principle, truth, inspiration, or the other factors that we’d generally like to see in those who purport to serve the people. It becomes a game of Don’t Displease the Master so one can move “up” the ranks.

            In that kind of culture, abandoning one’s own intelligence and developing an immunity to embarrassment become second nature, as it must.

          • Clearly then we disagree on the root cause of the ploy – you think they really are that dumb, I think they aren’t but they think their voters are.

            It’s sad that those are the two choices with the Harper Government [TM].

          • Ah, so you “remember how the darkness doubled”, & hey, why watch Television when one can just listen? Which reminds me, half the guitar played on the album Marquee Moon is played by Richard Lloyd, a then devotee of heroin, & a rather functional junkie!

          • I forgot the fundraising angle. My bad. I wonder if she was “told” what to think?

  5. Anti-intellectual, anti-science, pro-creationism….that’s the legacy of Harper’s govt.

    The Dark Ages.

  6. Like most of her fellow travelers in the Con universe, Ambrose prefers made up facts to actual ones.

  7. Shouldn’t the Minister of Health have some formal training in health care?

    • But then you’d have to have a military type in charge of the military, and a FNs in charge of FNs and an economist in charge of the economy and………

      • But Peter Mackay had experience with the military. And don’t forget that Snobelin had experience with education in Ontario. And Harper IS an economist is he not?

        I don’t seriously believe that it needs to be a hard and fast rule that ministers need some kind of bona fides for the portfolio they purport to run. But facts are facts, really. They ought to have some kind of proven intellectual capacity to govern. Reading comprehension would be a great start.

        • Mackay is a lawyer, never been in the military. Snobelin is a high school drop-out, and Harper only has an MA….not an economist.

          I’d prefer qualified people.

          • Teh irony it is lost…

          • Ahhh well that’s why I use LOL…but then people get upset about it.

        • And that’s why Clement is so good overseeing the Treasury – he’s a magician with numbers.

  8. Why Punish Pain?
    A hit of compassion could keep drugs from becoming a crime problem.
    by Gabor Maté

    http://www.yesmagazine.org/issues/beyond-prisons/why-punish-pain?b_start:int=0&-C=

    All drug addicts, even (or perhaps especially) the abject
    and marginalized street user, seek in their habit the same paradise de Quincey
    rhapsodized: a sense of comfort, vitality, and freedom from pain. It’s a doomed
    search that puts in peril their health, societal position, dignity, and
    freedom. “I’m not afraid of death,” another patient told me. “I’m more afraid
    of life.” What kind of despair could lead someone to value short-term pain
    relief over life itself? And what might be the source of such despair?

  9. Has Ms. Ambrose reviewed the evidence?
    Can she read?

    • I suggest a read of the studies of the Vancouver InSite experiment to understand what she probably meant. On the specific issue of reduction in heroin use, the evidence showed no particular effect up or down. The positive effects were on the health consequences to the people who participated. Whether it was effective depends on which of those two objectives you believe is the important one.

      • You betray your ignorance as InSite is not a heroin maintenance program, it is a safe injection site, a quite different program as InSite users have to bring in their own drugs to inject. However, InSite stats show addicts who use it are MORE, not less likely to enter detox programs ( a detox center is located directly upstairs from InSite) than those who don’t use it.

        Vancouver had an earlier heroin maintenance pilot program, NAOMI, which, like similar European programs, was found to have significant health & societal benefits.

        Don’t bother trying to defend Ambrose’s PMO issued talking points. They’re indefensible. Her/the PMO’s position represents a political, not an evidence & health-based, approach to medicine. In fact, it’s a political position intended to pander to the most ignorant, mean-spirited, irrational, hypocritical, bigoted red necks in the Tories’ voter base. This is not leadership. The Tory position is irresponsible & shameful.

        • The insult notwithstanding, I agree with you that InSite had health benefits and its objective was harm reduction not treatment. Because of that, Ambrose’s comments are misleading. But probably not strictly incorrect.

          Kerr T, Stoltz JA, Tyndall M, Li K, Zhang R, Montaner J, Wood E. Impact of a medically supervised safer injection facility on community drug use patterns: A before and after study. British Medical Journal, 2006; 332(7535): 220-222.

          • Why cite one British study when there is this ?

            supervisedinjection.vch.ca/research/

          • It’s not a British study, it’s the Canadian study about InSite in Vancouver, and the web page you provide refers to it. The British Medical Journal is a prestigious international medical journal that accepts submissions from any country.
            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1352057/

      • Ah – no. The studies she is ignoring are not the Insite ones. Of course this government ignored them when Insite was on the block a few years ago. So either you’re as ignorant as she is, or this is an attempt to mix everything on the subject of drugs together (including marijuana legalization) and then spout populist ‘common sense’ Reefer Madness inspired bumper sticker messages, aimed at the next election. The Con Party is already fundraising on it.

        • Again, apart from the insults directed at me, I agree with you.

          • Well, then I really have no idea what your point is.

  10. Harper’s gang is so shamelessly hypocritical & dishonest on the issue of substance use & abuse. Look at any photos or videos of Harper’s cabinet or caucus & you will see unhealthy substance abuse is evidently rife among Harper’s gang, including the PM himself. Significant overweight & obesity is conspicuous among Tory MPs. Trans fat & calorie-laden junk food, & food addiction kill many thousands of Canadians yearly via deadly obesity related diseases such as heart disease, cancer, & diabetes, diseases dreaded heroin does not cause. In fact, unlike our legal popular substances, properly & hygienically dosed heroin does zero damage to the body aside from creating addiction. But many of our legal substances cause addiction too. The most damaging & deadly popular substances by far are legal ones, tobacco, alcohol, & food addiction. Tobacco still kills a staggering 40K+ Canadians each year. All illicit drugs combined could never come close to causing the carnage smoking, booze, & obesity each cause.

    The most dangerously impairing drug isn’t heroin, cocaine, ecstasy, LSD, meth, or dreaded “bath salts”, it’s good old alcohol, the drug most closely associated with violence in the form of road & other accidents, assaults, suicides, domestic abuse, & homicides, not to mention it causes deadly heart & liver disease, diabetes, & cancer. Yet it’s heroin Minister Ambrose irrationally wants to demonize, a drug which is far less impairing, less damaging, & less deadly than alcohol.

    Drugs prohibition is a historical & cultural aberration, just 100 years old. For almost all of human history it was viewed as a human right to consume psychoactive drugs as one so chose. Introducing foolish prohibition laws in the early 20th century was a reckless social experiment that’s failed miserably. We had far fewer “drug problems” in my grandparents’ time when heroin, morphine, cocaine, opium, & cannabis could be purchased legally at the local apothecary. The worst so-called drug problems today are prohibition problems, direct outcomes of ill-conceived drug laws, not due to drugs themselves.

    It’s irrational to tolerate one set of deadly substances while unjustly demonizing & criminalizing another set of far less deadly ones & their persecuted users.
    End Tory hypocrisy & injustice. Stop the failed & counter-productive war on drugs.

    • Nobody could have said it better. Just getting tired of that circus in Ottawa, there because they look good, etc, etc, but what in hell does each of them know about what is going on in the world re cdns wanting to be able to make their own choices, be it abortion, drugs, opportunity to choose assisted death and whatever else is going on in the 2000 years. The obesity running rampant in the House is disgusting. Looking forward to see how much those people have gained (enlarged) after all those public appearances and around the world trips on our dime where they inhale at thosse banquet tables. Am I really being nast y?????????????

  11. In all fairness to Ms. Ambrose, there is no evidence that this treatment will get anyone off of heroin in the short term and that is likely what most people find upsetting about the idea of treating people with an illegal substance that has no clear end in sight. You can malign people for their caution or you can try to understand their sentiment and admit they have a right to feel worry. Then you can admit that although other countries have embraced this treatment, they didn’t do so without the same controversy and conservation that we in Canada are entertaining right now. This treatment is the lesser of evils. It isn’t perfect but it is better than the alternative.

    • But if that were true about what they find upsetting, and they were intellectually honest, they’d've been screaming about methadone treatment for years. Instead they’ve just decided to attach the word heroin and see if it gets them any cashola.

      • You believe Rona knew about methadone treatment? How? methadone is not an illegal substance? She only knew about the dicytlmorphine because the researchers had to apply to the federal government for special permission to use it due to its illegal nature. How would Rona who isn’t a heathcare provider or any average person really know who methadone therapy works for people addicted to heroin. Did you understand that that those addicted to heroin are on often on methadone for years and some never get off of it? Most people didn’t know that and now that they do, many have that same sick sinking feeling that they wish that they didn’t know because it just makes it more real how how devastating these kinds of drugs truly are. Let’s face it, nobody is thrilled about the treatments. They are not a real success story. Rather, they are the lesser of evils and we are better to be honest about that from the get go. This treatments keep those who are stubbornly addicted alive and out of prison. Until we developed something better, they are all we have and they are the cheapest and most realistic alternative to using incarceration for addiction therapy. The other reality people will have to accept is that while incarcerated many people are getting their hands on illegal drugs so even incarceration isn’t the answer to keeping people off of drugs.
        As for the CPC raising some “cashola”, ya that’s politicians for ya. Of course if Justin Trudeau complains, they can just mention the little fact that while an MP, he collected a speaking fee of $35 K from the Canadian Mental Health, an organization that finds housing and employment for the same people that they are denying this treatment to….those suffering from mental illness and addictions.

        • I did not and do not know all the details of methadone treatment, though I don’t consider myself rare for previously knowing such a thing existed. I am not surprised by anything you say above, and am willing to accept it at face value.

          And I’m not even the freakin’ Minister of, like, Health.

          I would expect people to listen to those in the know, weigh the options and make the most efficient use of resources within a realistic framework. And a whole bunch of times, that’s usually going to mean the people doing the job are doing as well as could be expected. Nobody gets points with me for knee-jerk “It’s just as simple as I say it is!” reactions, and if you’re going to cater to it you deserve the disgust of Canadians.

          • GFMD, you are pretty naive. You expect “Canadians” reaction to news that the government won’t be supplying heroin to addicts to be “disgust”. Hello! Most Canadians never understood the governments were providing opioids long term to heroin addicts. You have really high expectations of “Canadians” that just aren’t realistic.

        • Oh come on – she couldn`t have read a one paragraph briefing on this without the word methadone appearing. As uninformed as I think she might be – that is stretching it beyond belief.

          • In fact, she felt informed enough on the topic to say (wrongly) “there is no evidence…”.

            It might be one thing for a Minister to not know about a topic, as healthci posits. It’s another to make a policy statement based on not having thoroughly looked at the topic. But THEN to think that you have a strong enough handle on the situation to state there is no evidence contrary to a position when you clearly don’t (and when there is in fact such evidence) – that might be an even worse scenario than we’ve thought.

          • Yup, the whole thing is a repeat of Tony Clement`s handling of Insite. He couldn`t counter the expertise so he dismissed it with the silly ‘ it just doesn`t seem right’ . He also announced around the same time that the government did not believe in harm reduction, which is unbelievable in the 21st century.

          • The handling of Insite was politically motivated. It was a win-win move by the CPC. They pleased their base by going to court. When they lost, they had no choice but to leave the clinic open. This treatment will end up exactly the same way because despite their carrying on, healthcare is under the auspice of provinces.

          • Vancouver Insite is open but there are no others. It was to be a pilot project. Victoria has wanted one for years, no hope of it with this government. I see Ottawa has decided it wants to open one it will be interesting what success it has. Healthcare of course is a provincial responsibility, but both Insite and this heroin treatment rely on exemptions by the Feds.

          • The challenge in court which the feds lost set the precedent for future Insite locations…the Supreme Court of Canada ruled that the clinic saved lives.. It is now up to provinces to decide whether or not they want to open more of the clinics. As I pointed out, the researchers in this study are already saying they will likely take the feds to court and when they win, the province will then decide whether to fund the treatment.

          • What was your reaction to learning that some people have been on methadone for 15 years?

          • I am not surprised.

            it could very well be possible am more intelligent, informed and logical than the average Canadian, or at least your peer group. It would explain quite a bit, no?

          • My peer group works in mental health and addictions so at least your claim to being more informed than them is erroneous…..as for being more intelligent…hmmm, I am not sure what you are basing that supposition on. I am fully in favor of these treatments because at present there is no alternative that is better. However, I am not naive enough to doubt that many people do not see addiction as an illness and that mental illness is not treated by a large group of our population with the same sort of respect that other illnesses are afforded. The bigotry exhibited toward mental illness and addiction is every bit as real as the bigotry shown toward certain religious groups in this country.

          • how can you claim that your peer group is (apparently entirely) medical health and addictions and yet also claim that people are shocked when they learn about medical health and addiction treatment?

          • I have worked in psychiatry for 18 years. Do you think everyone I encounter in life works in psychiatry and is well versed in addictions treatment? Even patients I meet who have other mental illnesses are not necessarily compassionate toward people with addictions. How many ex-smokers do you know? They are the most militant people about how everyone should be able to quit smoking because they did.
            Read the comment from “make the right choices in life” and then you understand how most Canadians see problems of addiction.

          • I stand by my comment as most other Canadians, your whole argument is after the fact.

          • Hey, I don’t doubt you do stand by your comment. It has been my experience that many many people feel exactly the same way you do about people who suffer from addictions and it has also been my experience that their feelings aren’t based on any real scientific knowledge. You seem to feel that physicians and other healthcare workers who specialize in addictions treatment and you yourself have the same level of knowledge when it comes to the validity of the “opinions” expressed on the subject because you deny the value of any scientific research gained in the area in an attempt to support your own beliefs. That is of course your right but it makes it difficult for you to support any other scientific data because if one kind of scientific data is biased than isn’t all scientific data biased? How do you trust a physician to provide you with any treatment based on scientific data if the data can’t be trusted?

          • Why should people’s attitudes dictate treatment options? Surely you’re not suggesting this.

          • No, treatments should be based on their safety and efficacy. The Supreme Court of Canada would allow the treatment because it saves lives. At the same time, people do have the right to express their discomfort with how their healthcare care dollars are being spent and whether the treatments being offered are in the best interests of patients. We certainly have no issue with people having active debates over whether medications to treat ADHD and depression are over-prescribed. As well, we debate vaccination ad naseum. Certainly, we can be adult enough to accept that people want to debate the treatment of addictions.

          • An adult discussion is one thing. Denying the existence of studies that provide evidence that the treatment works is something entirely different.

          • Again Keith, the treatment only works to keep people out of jail and away from street heroin. For many who are cure-oriented, that is not a good enough excuse. However, that is where the Supreme Court of Canada will step in and decide the treatment is valid and cannot be withheld.

          • I knew all about it. When I was studying Criminology in the late 70`s metaodone was being used, but wasn`t considered the answer back then. And as I recall the Brits were prescribing heroin to addicts then. As long as I`ve been following addiction treatments it has been known that there a small percentage of addicts that will never be able to live substance free.

          • Methadone does work for most people. According to the UK website, the dicytlmorphine injections have only been introduced in the past few years to treat a stubborn 5% that don’t respond to the methadone and it is controversial there too. You might be aware that there are people who will never get off opioids and heroin but it isn’t common knowledge and it is pretty safe to say that it is disturbing to most people that the taxpayer is providing heroin to people who are addicted to it. It is not an easy concept to wrap your head around that there just isn’t a better option. People are very “cure” or abstinence oriented when it comes to addiction therapy.

        • I knew all that & I’m not in the health profession (or involved with drugs). So you’d think the Minister of Health would have people who would bring her up to speed on such things before speaking. Surely someone in the Ministry has a clue…?

          • I am not saying someone doesn’t have a clue. I am just saying, many Canadians are going to have an issue with treating people addicted to heroin with heroin, especially on an ongoing basis with no end in sight.

          • Maybe so. And maybe Rona can make a reasoned argument as to why the government should not provide the treatment. But denying the existence of the evidence is definitely not the way to go – not if she wants to be taken seriously by anyone with half a brain.

          • Keith, people are used to addictions treatment getting people off of substances in a relatively short period of time. In that vein, this treatment is a failure. However, this treatment was never intended to get anyone off of the substance per say but rather keep them alive and out of jail until they mature out of using the substance, which can be years and years down the road.

    • Would you provide her with the same defence if she was preventing patients from receiving palliative care, terminal cancer patients from receiving chemotherapy, or any of the numerous other treatments that are given for illnesses without any expectation of curing the illness?

      • Deference, lenny? Haha? It isn’t deference. It is simply the same mannerly way I try to treat all people who struggle trying to come to terms with understanding how providing what is undeniably a troublesome illicit drug to a person addicted to the drug can be the right thing to do.
        Frankly, lenny I even try to treat you a a mannerly way even when though you never treat me in kind. To suggest that I have an issue with “treatments vs. cures” is quite ridiculous given the fact that I work in psychiatry where there are almost never any cures. Further, if you really paid attention to some of the people who are on here voicing their outrage about Ms. Ambrose’s “stupidity”, you would know that they are the same people who often voice outrage about physician’s failure to provide cures for illnesses. Others complain about the way the pharmaceutical industry and healthcare providers exploit patients for profit by prescribing drugs with horrible side effects, so pardon me if I caution some of them to be just a little understanding of those who have issues with automatically accepting these controversial treatments.
        Now, do you really want to discuss palliative care and cancer therapy to decrease the suffering of patients? In what country has either of those treatments ever been considered controversial? This treatment…dicytlmorphine injections is considered controversial even in the countries where it is now practiced. It has not been an easy decision and the physicians that provide the therapy are not pretending it is a “no-brainer”.

        • Somebody on the street might deserve a little time to come to grips with it. It’s ambrose’s job and she’s supposed to be qualified.

          • Like it or not, Canadians relate to politicians that act like them…the guy on the street.

        • Ah, I didn’t see this response.

          “Deference”? WTF?

          ” I try to treat all people who struggle trying to come to terms with
          understanding how providing what is undeniably a troublesome illicit drug to a person addicted to the drug can be the right thing to do.”

          Which is an absolute pile of bullsh#t. Ambrose isn’t some poor fool “struggling to come to terms” with anything. She’s the fully briefed Minister of Health. She knows exactly what she doing when she tells Doctors that they can’t provide the treatment they’ve determined that their patients need. And she’s tossing those patients in the toilet (and some inevitably to their deaths) to score some cheap political points with the slack-jawed idiots that send her and her party money.
          It’s psychopathic.

          • lenny, for a supposed bright guy, you don’t understand political strategy worth crap. The researchers will take the government to court, just like with Insite and the province which runs healthcare will provide the treatment. Get your head out of the sand and live in reality. This crap goes on all the time. Programs are being de-funded all of the time. Physicians and nurses are being bullied all of the time. Patients will be protected by their healthcare providers just like they always are. Meanwhile, the CPC will use this to raise money from people like “make the right choices in life” (see comment). What you don’t understand, lenny, is that alienating people isn’t going to open their ears to education. I didn’t hear you on here calling the Quebecers who are supporting the PQ values charter, “mouth-breathers” so you obviously have some insight but when it comes to the CPC, you completely lose it.

          • Notwithstanding the mouth-breathers crack, lenny has a point.

            First, just because this is political ‘reality’ doesn’t make it acceptable.

            Second, you as well as anybody know what kind of a skewed picture the CPC is painting of this situation. On this issue, they are actively promoting the kind of ignorance you rightly bemoan, and are twisting it to serve themselves. Further, if this is going to unravel into a lost court case, isn’t it irresponsible to proceed on that basis? Governments should generally try to avoid moving ahead with lost-cause court cases in developing policy, shouldn’t they? If they don’t, we should call them on it — not shrug our shoulders and say ‘oh well, that’s politics.’

            You’re right, alienating people isn’t going to open their ears to education. However, deliberately miseducating people isn’t doing anyone a favour, either.

            I can let a lot of political shenanigans wash off my back, but this one really sticks in my craw.

          • I sorry if I am cynical and shrug my shoulders and seem to say “oh well, that’s politics” but I live in Alberta and deal with these politics ALL of the time in THIS business so I have a hard time getting too outraged because what I have learned is that you can never underestimate the stupidity of those in charge. If a person let themselves get outraged and fed up, they would have to quit doing the work and that is not acceptable.
            What the CPC is doing is exploiting and promoting an ignorance that already exists….just as the PQ is exploiting and promoting bigotry. I do bemoan it but I also know that mocking people’s ignorance does not bring them around to thinking differently. It insults them and makes them dig in and dismiss everything you say. We want to open up this conversation and make people think about what the options are and hopefully realize that although these treatments aren’t ideal, they are the best of what is available. I do not believe that the courts are the proper venue for developing policies but sometimes it is necessary when there are controversial treatments offered and consensus is unlikely. In mental health, we use legal means all of the time to test the validity of confining patients to hospital and forcing treatment upon them. It is a way of ensuring people’s legal and human rights are being respected.
            As for political shenanigans, I live in a province where the government was threatening to fire doctors who were advocating for better care for their patients. Do you think that one “washed off my back?” No, it did not but solider on and don’t let them win.

          • ‘What the CPC is doing is exploiting and promoting an ignorance that already exists….just as the PQ is exploiting and promoting bigotry.’

            Funnily enough, that’s the other ongoing issue that sticks in my craw, too.

          • Yes, it is very disappointing but I am quite convinced that these people who hold these beliefs which are different from ours are certain they are right. I for the life of me cannot understand how anyone can find fault with an ER doc wearing his turban to provide life-saving care and at the same time, I cannot understand how anyone would not be sympathetic to the plight of a person who is severely addicted to a devastating substance. I do not believe though that anything is served by not at least acknowledging their concerns and then challenging the validity of the so called facts they are basing their beliefs on.

          • What is the political strategy that I don’t understand?
            I’m pretty sure I just did describe reality – both political and otherwise.

            So, I really have no idea what you’re trying to say.
            That the government shouldn’t be criticized for what the doing because what they’re doing is reality?

            As for “educating” that part of the base that is capable of believing that they’re more qualified than doctors to determine how to treat patients, I think there’s about as much chance of that as getting those hardcore cases entirely off heroin.
            Not to mention that there is a segment of that group who may accept medical expertise, but are happy to deny the treatment anyway – either because they don’t care what happens to addicts, or they believe that addicts deserve to suffer or even be punished.

          • The CPC will exploit the misinformation and bigotry toward people who are addicted just like the PQ is exploiting the religious bigotry in Quebec. The courts will step in and the researchers will win because healthcare is up to the provinces. The treatments will proceed. I never said political groups shouldn’t be criticized. I said the treatment is controversial and many Canadians will feel that way. As for educating the base, I have said before that there is no point in appealing to anyone’s sense of common decency. Better to appeal to dollars and cents. It costs about 1/3 of the price to treat these 5% of the all heroin addicted patients yearly with dicytlmorphine injections than it costs to keep them in jail which is where they will end up with out treatment. According to the polls, there are a huge number of Canadians who are bigots (don’t want their ER doc to look after them if he is wearing a turban). Therefore, it would not really be a great stretch to believe that most Canadians don’t want to use their healthcare dollars to buy heroin for those who are addicted. Sometimes, lenny, the nasty work of politicians is just an ugly reflection of what is the reality in the world we live in. They are picking the low-hanging fruit.

          • I’m not sure why you’re telling me this.

            You were the one making excuses for Rona Ambrose and suggesting she just needed to be better informed.

          • I am not sure why you question my motives, lenny but you do and I respond to your questioning. I explained that Rona Ambrose is a reflection of the average Canadian. To be somewhat sympathetic of their plight in coming to terms with what is no doubt a troubling concept in terms of medical treatment is the job of those who make the treatment decisions in healthcare. It is expected. The treatment will proceed because its efficacy and safety are well established and so are the legal precedents for offering it. I have no doubt of Rona Ambrose’s lack of insight and information. It seems many on this thread question whether she can actually read but somehow my doubts as to the veracity of her medical knowledge bothers you immensely. You would would paint her as brilliant while others would describe her as barely literate, obviously she falls somewhere in the middle. Afterall, she did vote against sex-selection abortion not realizing it was never an issue in Canada.

          • No, I haven’t for a moment suggested she’s “brilliant”.

            However she is this country’s Minister of Health. As such, she has full access to all the information she needs to make informed decisions and staff who’s job it is to insure she’s is fully briefed.
            The picture you paint of some poor woman sitting alone in her office plagued with doubts about allowing doctors access to heroin, and succumbing to those doubts due to a lack of information is laughably absurd.

          • I never said anybody is plagued about “allowing doctors access to heroin”. I said people are concerned about giving those addicted to heroin, heroin.

          • Sure, change “doctors” to “addicts” in my comment if you want. It doesn’t matter.

          • Excuse me? You are the one who is trying to change MY comments, lenny. I am just correcting you.

      • The particular guy you are talking to specializes in bizarre excuses for CPC members .

        I don’t like to put words in anyone’s mouth, but right now it kinda looks like it’s OK because the person selected to be responsible for legal medical policy had never heard of methadone or newer, more powerful heroin substitute, then went ahead and made a knee jerk reaction about it. As a fundraising ploy.

        Even if it’s true, that shouldn’t sit well with Canadians.

        • Yes, it is a shame, this particular “woman” who is a psych nurse specializes in pointing out the reality that Canadians will be questioning whether this treatment is wise and won’t appreciate a bunch of pretentious prigs demeaning them their right to do so. Better to shut down the conversation by calling people’s contributions “bizzare”. That way, we can just upvote each other’s comments and clap our hands and congratulate ourselves on how really witty we are. Meanwhile, nothing is solved and our party is still not in power but oh well.

          • There’s really no excuse for you, as a healthcare provider, to be an apologist for Rona. If she isn’t deliberately lying then she is hopelessly informed – either of which is inexcusable in a Minister (or, rather, should be but seems SOP for this government).

          • I am not an apologist for Rona Ambrose, Keith. I am a realist, pointing out what many Canadians think. Frankly, I am getting really tired of explaining that I know exactly what the CPC is doing and I think it is disgusting. They are doing exactly what the PQ is doing. They are exploiting misinformation and bigotry for dollars and votes. In the end though, healthcare will win because the researchers will take the government to court.

          • It doesn’t matter what many Canadians think; it is her job as Minister of Health to be objective. Denying that evidence exists when it clearly does is far from objective. She is either lying or incompetent – and so she fails at her job. It would be different if she trotted out studies that contradict the evidence cited by Wherry or otherwise gave reasons why she thinks it is the wrong thing to do despite these studies, but she doesn’t – she just baldfaced denies the evidence exists. If you don’t call her on it – if you go so far as to say you understand why she is lying – you are an apologist.

          • Keith, she said the treatment doesn’t work and she is right in the way that it doesn’t work to get people off of heroin. It was never intended to get people off of heroin. That is a fact. Denying that is a fact gets us no where. Accepting that people have a long way to go to accept that it is okay to give heroin to heroin addicts is reality. Now, call me an apologist if you want. I am realistic that people, including the ministers who ARE people, whether you want to admit it or not, have difficulty with accepting things and need convincing. Thank you for your discipline but I am really finished with it.

      • I take it that’s a “no”. Because her actions in those cases would be completely indefensible, as are her actions here.
        The only thing that can be said about Ambrose and this government “in all fairness” is that deciding to deny patients treatment against the wishes of their doctors to score some cheap political points among their mouth-breathing base is absolutely f#cking obscene.

        • I did respond to you, lenny but as usual, you prefer to converse with yourself.

          • While I see now that you responded to my question, you certainly didn’t answer it.

          • Sorry if it offends you delicate sensibilities, but anyone who can sit on their couch and say “sure I don’t know this first thing about heroin addiction or treating it, but I’m going to deny those patients the treatment that their doctors that do know are providing, because I don’t like the sound of it,” is getting off easy with “mouth-breather”.

          • I did answer your question, lenny. You chose not to accept the answer.

    • You are being completely disingenuous. Did you look at the flyers sent out by the CPC politburo to see who is doing the “upsetting” through state-sponsored misinformation about the realities of this program? I am floored by how you can maintain this disconnect between what you clearly believe viz SIH and the behaviours and attitudes you try to rationalize away in blind support of the CPC platform.

      • Disingenuous, ha! Did you read my other comments?
        Am I surprised CPC would capitalize on making money off of the suffering of others? Absolutely not! Are they the only politicians to do it? Unfortunately, no.
        Are there Canadians who are going to question the efficacy and safety of a treatment that doesn’t get people off of heroin? Yes. Should they do so? Yes. Should we mock them? No. Should we educate them? Yes.

        • That’s fair to an extent, although a) people should realize that their immediate reactions and lay opinions are going to have to take a back seat to the researchers and front-line workers who handle the matter every day, and b) it’s a fair matter of concern when the Minister of Health is not the educator but among those needing education (and collecting donations over it besides).

          • Of course it is not right to collect donations but everything these political parties do is about money and gaining power. I am sorry if I don’t pay much attention to that because I work in a industry where it is is all about politics continuously and they are laying off nurses and hiring nursing aides with little or no education to replace them; bullying doctors; defunding programs and closing psych beds and then realizing they made big mistakes and changing their minds….all I try to do is keep my mind on the patients because otherwise you lose it. I believe the researchers will sue and win the right to continue the treatments, just like insite did. At any rate. This was obviously a knee-jerk reaction but I believe many Canadians will have the same reaction because they will feel the same way. We need to educate them but honestly there isn’t a lot of sympathy for people with addictions. People don’t see it as an illness although it is.

          • It obviously wasn’t a knee-jerk reaction. It was a cynical, fully informed reaction playing to the knee-jerk reaction of the mouth-breathers.

          • I was reminded this morning watching QP that the convention is coming up. They’re desperate for something to rally the base with.. This seems unlikely but given that they’ve seen fit to fundraise on it and combined with Trudeau’s marijuana it could give them something to whip supporters up with. Look how hysterical Rick Omen is over it.

          • “mouth-breathers”? Charming as always, lenny.

          • The people who need to be educated are the addicted, not the Canadian population as you are trying to imply.
            The only people who can call this an illness are those who were born with the addiction due to mother being a drug addict, all others are due to learned behavior which now has become a problem.

          • I am sorry to say that you are not correct in your assessment that addiction is not an illness. If you do research, you will learn there are changes in the brain that make a person who is addicted to a substance crave the substance to a degree that they become “powerless” (in the words of those who attend AA) to abstain from taking it. That is why those in 12 step programs live “one day at a time”, promising themselves each day that they won’t imbibe that day. Those addicted already are educated about their misery. If you do nothing else, read Russel Brand’s writings on what it is like to be addicted. He describes it very well.

          • You are entitled to your opinion as i am mine.
            Mayby if these addicts would of listened to the presenters of the perils of drugs when they were young, they would not have their issues today. For you to tell me to research the subject is quite comical as we all know that todays research is so biased that it is not worth reading.
            Bottom line is everyone has a choice in life.

          • What about addiction to tobacco and alcohol? Do you not know anyone who has had an addiction?
            As for research, do you not believe in any scientific research? What about research into heart disease, diabetes, stroke?

          • Yes I do, I was a smoker and one of my siblings was an alcoholic.
            So speaking for myself i became addicted to smoking. I wasn’t born with a cigarette in my mouth, i chose to smoke. (learned behavior).
            As far as research goes it has become too biased.
            What ever happened to actually giving the reader the true facts vs the individuals bias.
            Have you ever noticed how todays Press no longer provides the reader with the facts so the reader can make an informed opinion on subject matter.
            I am now rambling, sorry about that, anyways i have enjoyed the banter you have a great day.

          • Sure you chose to smoke some cigarettes but had you been as wise when you started smoking as you were when you wanted to stop, you would have never started and that is what is really the issue here. We understand that humans are fallible and we don’t punish them for making bad choices. We want to keep giving them chances to do better and make better choices. We also understand that we are paying taxpayer dollars for those bad choices so we want to get the best bang for our buck. We know that people who are addicted to substances are not bad people. They are just people who made bad choices and then ended up addicted to a substance. Some can quit, some can’t. Some have a lot of great family support and good reasons to quit. Others have none. When it comes down to it, we have to decide what is least damaging to the person who is addicted to the substance. Do we let them die out on skid row or do we offer them some sort of life even if it means we give them a substitution for what they are addicted to. If that substitution means they can have a life and maybe even a job, that is seen as a win because many of these addicted people have already had children and even if those kids are in foster care, it is best for those kids if their parent who is addicted, is having some success in their life. This is how this kind of treatment decision comes about. It isn’t perfect but it keeps people alive. It makes people’s lives worth living and it keeps them out of jail. It provides just enough of the drug to keep their cravings at bay and they aren’t using dirty needles or dirty drugs that are cut with all kinds of dangerous substances. In time, most people “outgrow” their addiction. While the choice to take the first injection of heroin is definitely a bad one and it is a choice, it isn’t long before a person is addicted and most people falsely believe it won’t happen to them…that they won’t become addicted. I know you probably love your brother and you are probably very grateful he gave up alcohol but he likely had a lot of support. You would probably love him even if he wasn’t strong enough to do it. I don’t expect you to change your mind overnight and embrace this therapy but I would like to think about what you would think if your son or daughter had made a bad choice and tried heroin and ended up addicted and couldn’t get off it. Would you want them to be “thrown away” or would you want healthcare providers to give them that second chance at life and give them a chance to outgrow the addiction?

          • Well good for you that you were able to quit. Maybe you weren’t addicted to begin with. Not everyone who takes up a given drug becomes an addict. You really can’t judge the experiences of every other user based solely on your experience.

          • Anyone else you’d like to see denied medical treatment because they should be made to live with their choices?

            How about concussed hockey players? Speeding motorists? ATV and snowmobile users?

          • The obvious difference is that playing hockey, etc. gives you a chance of having a medical condition. Heroin users know they’ll get addicted.

          • What you propose sets a trouble precedent. Will be only treat medical conditions that aren’t a result of a predictable activity on the part of the patient. Will be stop treating lung cancer if it is the result of smoking? Will we stop treating conditions related to obesity? How about trauma from car accidents when the driver was speeding or not wearing a seat belt? What about people who have a strong genetic history of heart disease and chose to re-produce. Should their off spring still get treatment for heart-related conditions?
            We don’t usually punish people in Canada for making poor health choices and getting ill as a result of those poor choices. Do we want to start doing that?

          • Let’s say you deliberately do something really dumb while driving, and have an accident that costs you a limb. You made the choice to drive like an idiot and now your body is changed forever. Can you will your limb to regrow? Should you be denied a prosthetic because the injury was due you something you deliberately chose to try?

            Some choices are difficult, if not impossible, to undo. You seem to want to punish people forever for those choices. You may want to bear in mind the greater cost to society of not providing this treatment.

      • that’s a bit too far. healthcare insider has at times gone to bizarre lengths to concoct implausible scenarios to try to cast the wrongdoing of some CPCers in better light, but he has also at times offered criticism of Conservative policy (sometimes very thoughtful criticisms).

        • Agreed.

          • After two days I am withdrawing my agreement – at least on this thread. Thoughtful criticism has given way to mindless enabling of Ambrose.

  12. Like I said in the other thread, Rona Ambrose doesn’t care one bit about vulnerable addicted people in society. It’s a classic Conservative view: they did this to themselves, let them kill themselves.

  13. Heroin maintenance programs are directed at hard core, long term addicts who don’t respond well to rehab or opiate replacement therapy. As a taxpayer, I’d much prefer such addicts receive their drug free or at a low cost in a legal clinical setting than to face the alternative – the alternative being having my car & apartment broken into by desperate addicts compelled to steal to pay artificially sky-high black market prices for substances dirt cheap to produce. Addicts in drug maintenance programs are more likely to have regular jobs, lead more normal lives, & not victimize fellow citizens via property & other crime.

    IV addicts who don’t consume drugs in a clinical setting are also at higher risk of contracting chronic conditions/diseases such as HIV/AIDS & hepatitis, preventable conditions whose medical treatment is very expensive to taxpayers. Preventing cases of HIV & hepatitis saves taxpayers a bundle.
    Such addicts are also at much higher risk of fatally OD-ing due to uncertainty of dosage of unregulated black market drugs, or due to no medical personnel being present to revive an OD-ing addict.

    It’s also unacceptable our draconian drug laws compel women addicts to prostitute themselves under the most dangerous conditions. Thanks in part to our foolish drug laws, serial killer Robert Pickton was able to lure vulnerable women to his murder-farm by providing them with drugs & promising them more. He was convicted of six murders, but DNA & other evidence implicated him in 26 murders in total. Pickton himself claimed he’d killed 49.

    Drug use & abuse, & addiction issues need to be treated as social & health issues, NOT judicial ones. This is a saner approach, & one best for addicts, taxpayers, & society as a whole.

  14. Let me get this straight. The evidence that clinical heroin helps addicts is that they buy less heroin on the street? I guess we could cure tobacco related illness overnight if everybody just started smoking government cigarettes?

    I’m really looking forward to Justin Trudeau putting this into his election platform. Legalized weed and free government heroin. That’ll go over great with his base. Not so much with real Canadians.

    • No, you don’t have it straight.
      Get help for your reading comprehension deficit. Seriously.

    • Do you have to work hard to come off this dumb, or does it come naturally?

    • Yes, Rick that is one of the tenants of this treatment which is not a cure but rather seeks to lower the risk of harm to the person who is very stubbornly addicted to heroin. Street heroin is cut with all kinds of very dirty and dangerous substances that when shot into the body can have far more egregious results than just getting a person high. Further, the treatment of dicytlmorphine injections provides a person addicted to heroin with enough of the substance in a clean injection provided by a healthcare worker, so that the person is not tempted to go out and get heroin on the street by any means necessary, including through illegal acts that might harm other individuals and lead to incarceration. This treatment is found to save the taxpayers money because it keeps people who are stubbornly addicted to heroin healthier and out of jail at about 1/3 of the yearly cost of keeping them incarcerated. What the treatments also allow is the person who is addicted to lead a somewhat productive life while they mature out of their addiction. No one is claiming this treatment is perfect but it is better than the alternative. You seem to be under the mistaken belief that those addicted can’t get substances in prison. I am here to tell you they can and do. We taxpayers are paying a hefty bill to keep them there and they still aren’t abstaining. Therefore, the other alternatives aren’t really working. Now if you have another suggestion of something that might work better, by all means, suggest it. Addictions specialists the world over would be at your feet if you could provide a “cure”.

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