‘Under the guise of 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?