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‘Under the guise of treatment’

The Throne Speech and heroin-assisted treatment


 

Under the heading of “safeguarding families and communities,” the Throne Speech included this commitment.

Our Government will … Close loopholes that allow for the feeding of addiction under the guise of treatment

“Guise” is an interesting choice of word, defined in one sense as it is as “a way of seeming or looking that is not true or real.”

This commitment would seem to be a reference to Health Minister Rona Ambrose’s decision to prevent Health Canada from allowing doctors to pursue heroin-assisted treatment for their patients through the Special Access Program—a treatment for which Ms. Ambrose has insisted there is no supporting evidence, despite what the evidence suggests.

In an op-ed for the Vancouver Sun on Friday, Martin Schechter, principal investigator for the NAOMI study, worried about potential patients who won’t receive heroin-assisted treatment and defends the treatment.

Perhaps it’s time to do some lateral thinking. What if we could attract these people off the streets into clinics where doctors and nurses could treat them with diacetylmorphine, a safe and sterile pharmaceutical, instead of unsafe black-market heroin? What if this could free them from the treadmill of criminality, sex work and incarceration, replacing them instead with support, counselling and time to think about their future? What if this way provides them an opportunity to stabilize their lives and move on?

Wouldn’t this have a better chance of helping them than disease, crime, sex work and jails? The answer from the scientific evidence is a resounding yes. The effectiveness of diacetylmorphine over conventional treatments in this subgroup has been established independently by published clinical trials from Switzerland, the Netherlands, Germany, Spain, England and Canada. It is now being used in all of those countries except our own. The Cochrane Collaboration, considered to be one of the world’s most trusted sources of independent medical advice, endorsed the evidence about diacetylmorphine. But the minister disputed the science.

In a blog post last week, Gabor Mate challenged the Health Minister to explain herself.

Your reported comments were that there are already safe treatments for heroin addiction, such as methadone, and that there is insufficient proof that heroin is a safe treatment for drug addicts.  I find your statements puzzling at best. There has been no sign that you or your government pay the least attention to scientific data in formulating drug policies. It would be helpful if you were to cite publicly which studies you have consulted, which ones support your position, or how the many that do not may be lacking in scientific acumen, method or objectivity.

In her interview with the CBC, in which she claimed there was no evidence to support heroin-assisted treatment, Rona Ambrose referred to the work of Meldon Kahan. Dr. Kahan questioned the findings of the NAOMI study in a 2011 paper. Dr. Schecter and Dr. Perry Kendall (the latter is now the provincial health officer in British Columbia) then responded to Dr. Kahan. And then the doctors exchanged responses.

See previously: The politics of the heroin addict, Heroin-assisted treatment and politics-based medicine, Perry Kendall on heroin-assisted treatment and ‘No evidence,’ Minister Ambrose?


 

‘Under the guise of treatment’

  1. The researchers need to go to court. Thinking that they can convince the government to be reasonable is misguided. This is a political strategy to placate their voters and they won’t back down until the courts force them to. The researchers are just wasting time and breath.

    • ‘Thinking that they can convince the government to be reasonable is misguided.’

      I’d argue that the government’s position is reasonable — from the standpoint that, politically, their position is very easy to understand. Adopting this position, they can now demonize their political foes as being ‘pro-heroin’ (which you can read all about in the following Wherry post). The public, who don’t have the time or inclination to delve deeper into the issue, will take that as gospel.

      However, from a health care and public health perspective, the government’s position is completely unreasonable. They should be called out on it. As often as possible. It might not change the government’s mind, but if the government is acting in an unreasonable fashion, it behooves those ‘in the know’ to point it out. The public deserves to know what’s going on, and they can assess just how ‘reasonable’ the government is acting on this issue, with all the facts in front of them.

      • Unfortunately, much of the public will be skeptical about treating addicts with heroin and if you have read the threads online here you will know that there is little that those “in the know” can do to change their minds. At this point, it is about the patients who need care. Apparently, they have the medication for the next few months and the researchers need to get on the court action to make sure there is no interruption in the service.

        • I dunno. When people are being wantonly misinformed, and when the government is adopting dumb, politically-motivated policy, I have a real hard time shrugging my shoulders. But, you’re right, court action is a must.

          • Medical care based on political posturing is always frustrating. You don’t have to shrug your shoulders but healthcare professionals don’t have the kind of sway to change perceptions that one might expect.

    • Perhaps supporters of this government who also happen to be health experts should also send letters to their Con MPs asking them to figuratively remove their heads from their asses on this issue.

      • Yes they could do that but I wouldn’t hold out hope that it would work. The CPC is in a win-win situation with this strategy just as they were with the Insite clinic. They are dealing with a poorly informed public that deeply believes that somehow those who are stubbornly addicted can be saved from their addiction and that saving should not involve treating them with a derivative of the drug they are addicted to. These people they are pandering to are of the same ilk as those who believe that even if a woman is raped or if her life is at risk, abortion should not be an option because it involves taking a life. They are plucking the low-hanging fruit and it works because there are a lot of people who really feel that way, especially when it comes to people who they feel are at least partially to blame for the situation they now find themselves in. When the court rules for the patients and researchers, the CPC shrugs and says “we did our best to keep the drugs away from those who are addicted” and everyone congratulates themselves on attempting to save the sinners.

        • IOW, smart politics, dumb public policy. Sad that civic discourse and governance has come to this.

          • Yes but it hasn’t “just” come to this. It has been like this forever. People tend to be selfish and they don’t want their healthcare dollars spent on things that they can never see themselves or their loved ones ever requiring. Heroin addiction therapy benefits very few in our society and therefore, very few feel moved sufficiently to vigorously champion its funding. That is why I believe that if the other parties want to sell this funding they need to do it from a stance of the cost benefit of providing the treatment. This treatment has been known to keep those stubbornly addicted away from street heroin that is laced with all sorts of impure substances which cause health complications and increase costs to taxpayers due to increased healthcare encounters. Further, this treatment is shown to keep those addicted from committing crimes and thus keeps them out of prison. In short, this treatment saves taxpayers money and not just a little money. This treatment costs 1/3 of the cost per year of keeping a person incarcerated. The public may not have a lot of empathy for those who are addicted but they do care about their money being wasted foolishly.

          • No argument here with any of that assessment. Unfortunately, proponents of that utilitarian argument have access to fewer communications media than do the purveyors of self-serving propaganda.

            This discussion certainly puts the “cynic” in “civics”.

  2. In a twisted way, the CPC is doing a lot to raise public awareness of the need for a solid scientific basis in policy development.

    • Let’s hope. The cynic in me says far too many voters hear only the catchphrases; anything more complex than a 140-character tweet or 30-second ad is beyond their comprehension.

  3. Paging Dr. Kellie Leitch, paging Dr. Kellie Leitch…

    • On Friday, the good doctor called an NDP MP, Libby Davies, I think, “pro-heroin.” Seriously, that someone with her credentials can willingly sling this shit in HoC speaks volumes about the two-faced Leitch.

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