Federal position on medical heroin ignores evidence, hurts patients

Amid the uproar over crack in Toronto, a very different story about the complexities of addiction and the need for compassion is playing out in Vancouver: celebrated litigator Joseph Arvay is again advocating for addicts in one of Canada’s poorest neighbourhoods, Vancouver’s Downtown Eastside.

However, this new legal challenge should not be necessary.

In 2011, the Supreme Court of Canada ruled 9 – 0 that the federal government must make health decisions based on evidence.  As Chief Justice Beverley McLachlin wrote, “these people are not engaged in recreational drug use: they are addicted.”

Despite this ruling, Health Minister Rona Ambrose is pursuing public policy at odds with the medical evidence.  Minister Ambrose has stated “Our goal must be to take heroin out of the hands of addicts.”

But research shows that for some people, only therapeutic intervention with heroin derivatives can offer the effective treatment they need to stabilize and improve their lives. These are people who have been treated with methadone, but for whom methadone did not work. These individuals are typically among the most marginalized in Canada and have complex mental, physical, and emotional health issues.

The Health Minister’s denial of effective treatment means that these already marginalized people and their supporters must now go to court to access medical treatment.

This government denial has created two other significant problems.

First, Canadian taxpayer dollars are misspent.  International clinical trials had already demonstrated that heroin derivatives successfully treat heroin addicts who failed with methadone.

Yet to meet an apparent government need to create local evidence, Canadian investigators conducted research that demonstrated that heroin-assisted therapy was better than methadone for many addicts.  This research was published five years ago in the New England Journal of Medicine, but still has not been implemented here in Canada. Instead, the Health Minister is spending more taxpayer money to justify in court her decision to reject the Canadian research that cost taxpayers $8.1 million to create. There are better uses of public funds.

Second, government unwillingness to accept the international evidence meant that the research participants were in a study comparing methadone to heroin, rather than in a study to find the best way to use heroin.

Consequently, research participants were randomized to methadone even though the researchers knew that methadone did not work for them. Many believe that this was unfair and even unethical.

Those research participants who did receive the heroin derivative knew that, one day, the trial would end.  The end was tragic.  Without successfully addressed their physical suffering, they felt abandoned and cut adrift from the community they established during the drug trial, and were much more likely to engage in criminal or otherwise harmful behaviour to obtain heroin.

In a report prepared by some study participants and an academic, six people who received the heroin derivative suggested that better health was given and then taken away:

“I was in a bubble for 15 months… I hit those doors at 72 pounds, and you know, here I am now.”   “I was happy… you know, I wasn’t sick, I wasn’t running around trying to get $10 all the time.” “I learned how to be myself without having to look for money all the time. I learned how to do normal things.”  “It gave me a huge break in my life as an addict.” “I cried like a baby the last day I was there.”

From the perspective of both groups of research participants, the time for research had long ended. Arguably they were entitled to internationally demonstrated, evidence-based medical care.

This might seem a complicated area of public policy.  But drug addiction is simple in this respect: it is a disease that health scientists and physicians study and treat. When there is demonstrated effective treatment, that treatment should be offered.

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Juliet Guichon


Juliet Guichon is a professor in the University of Calgary Faculty of Medicine.

Ian Mitchell


Ian Mitchell is a professor in the University of Calgary Faculty of Medicine.

Stacey Page


Stacey Page is a professor in the University of Calgary Faculty of Medicine.

Christopher Doig


Christopher is a Professor in the Departments of Critical Care Medicine, Community Health Sciences, and Medicine at Cumming School of Medicine at the University of Calgary.

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