By Connie Carter and Susan Boyd
On October 3, 2013, federal Health Minister Rona Ambrose announced new regulations that became effective immediately to prevent Health Canada’s Special Access Programme from approving the use of prescribed diacetylmorphine* as a treatment for addiction for a small number of patients finishing the clinical trial SALOME, in Vancouver, BC. Health Canada’s Special Access Programme (SAP) allows practitioners to request access to drugs that are unavailable for sale in Canada.
Ambrose’s comments at the October 3rd press conference misrepresented the extensive evidence supporting heroin-assisted treatment (HAT). She claimed HAT is unsafe and expensive and not in keeping with her government’s National Anti-Drug Strategy. Her comments reflected the Harper government’s refusal to acknowledge the eight peer-reviewed research HAT trials worldwide that have found it to be a beneficial, safe, and cost-effective approach for patients where methadone and other conventional treatments have not worked.
Ambrose promoted the virtues of abstinence-based drug treatment failing to mention that Canada’s system of treatment programs is a patchwork of private and public providers. As the CDPC’s report on Canadian drug policy found, private treatment programs are expensive, and in the absence of national accreditation standards, these programs can vary in quality. Abstinence based treatment is also ineffective for many people with long-wait times for publicly-funded services.
Ambrose’s press conference included supporters who were called upon to back the federal government’s position. One speaker, Marshall Smith, a former political staffer with the BC Liberal Government, described his own struggles with drugs including crystal meth, and his recovery through abstinence-based treatment. Smith currently works for Cedars at Cobble Hill, a privately run drug treatment facility on Vancouver Island. Smith comes from a self-admitted well-to-do family, who can afford private treatment facilities that can cost upwards of $10,000 a month. Every person’s story of recovery and change is important, but with all due respect to Mr. Smith, it’s vital that no one person’s story stand in for the range of experiences with substance use.
Comments at the press conference reflected a narrow view of recovery from substance dependency and assumed that all people will benefit from conventional drug treatment approaches. In a turn about from previous calls for abstinence-only drug treatment, speakers’ called for expanded opiate-substitution programs like methadone. But HAT is only offered to patients who have failed repeatedly with methadone and abstinence-based programs.
Ambrose called Health Canada’s recent decision to approve the use of diacetylmorphine for 20 patients a “loophole” in the Special Access Program regulations. But the Special Access Program is supposed to provide patients with serious or life-threatening conditions, access to drugs on a compassionate or emergency basis and especially when conventional therapies have failed. Under these conditions, many of the seriously ill patients who enter HAT would certainly qualify for access.
No one knows better the concerns of patients in these research trials than SNAP, an independent Vancouver based group comprised of former and current members of Vancouver based HAT research trials (former NPA). SNAP advocates for human rights and access to appropriate health care for its members and has been working since January 2011 to establish permanent HAT programs. SNAP members also have first hand experience with the use of diacetylmorphine. Their experiences confirm the findings of other research studies that this drug is a proven safe and effective treatment for opiate dependency. Patients’ physical and psychological health improved, accompanied by decreased criminal activity and illegal drug use. Given the positive results from studies around the world and here in Canada, the federal government’s refusal to recognize the best treatment for this small groups of patients is an egregious violation of their rights to access to health care.
* Diacetylmorphine is the active ingredient in heroin. It is pharmaceutical-grade product manufactured by a company outside Canada. For the purposes of research trials, it is purchased and imported with permission of the Government of Canada.
