Tuesday, October 08, 2013

Prescription heroin and a health minister who doesn’t believe in science

Or, when do politically driven policies cross a moral line 
Health Minister Rona Ambrose has changed Health Canada rules to shut down a Vancouver research project that would test the benefits and risks of prescribing heroin to hardcore addicts.
Research in Canada and around the world has shown that prescription heroin is an effective treatment option for a small group of addicts. 
That’s not surprising. Some people face enormous difficulty moving away from heroin addiction, and research has found methadone and other substitutes are ineffective for them.
So the choice is simple. Prescribe heroin and help people manage their drug use and deal with their addiction. 
Or leave them to buy drugs on the street.
All the research has shown that - again, for a small group - prescription heroin helps the addicted person and society.
Switzerland conducted landmark research in the 1990s. About 1,100 addicts received prescription heroin. 
There was a massive reduction in criminal activity by those in the study. Employment increased once people were freed from the daily struggle to find illegal drugs. More than 80 people quit using entirely. 
And there was not one overdose death.
The Swiss government approved a permanent prescription-heroin in program in 2008. Conservative elements forced a referendum, and the Swiss - hardly known for wild social experiments - voted 68 per cent in favour of the program.
Canada has done similar research. The NAOMI project was a thee-year trial in Montreal and Vancouver that tested the effects of prescribing both heroin and a heroin substitute for confirmed addicts. (Participants had to have been through treatment unsuccessfully twice; the mean age was 40.)
The program showed prescribing heroin or Dilaudid, the substitute used in the test, worked. Almost 90 per cent of participants had entered treatment or quit using illegal heroin after one year. (Only 54 per cent of those on a methadone program achieved the same results.)
And those on the program spent far less money on drugs of any kind. The monthly median spending fell from $1,500 - $50 a day - to $400.
That is great news for everyone who has their car broken into or a bicycle stolen. People who need more than $50 a day for drugs do crimes.  
Remove that need and you reduce crime. It’s cheaper and more effective than building more jails. That should be appealing for a government concerned with reducing crime.
The Netherlands approved prescription heroin in 2004, after a study showed positive results. Prescribed heroin to an addict resulted in savings of $17,000 a year compared with methadone programs.
Any discussion of drug policy seems to skid quickly into extremes. Prescription-heroin programs are no panacea. A small percentage of users would qualify, people with deep addictions who have tried rehab and methadone but continue to buy and use heroin. Perhaps 10 per cent or less of all users.
For those people, and the community, the program would have benefits, and no negative aspects.
Ambrose says she killed the option because heroin is bad and doctors shouldn’t prescribe “dangerous drugs like heroin, cocaine, ecstasy and LSD.”
Everyone would agree a heroin addiction is bad. But most rational people would agree that managing the addictions of people who can’t quit makes sense.
And Ambrose’s reference to “dangerous drugs” is baffling. Alcohol is freely available, and is responsible for five times more hospitalizations in B.C. than all illegal drugs combined. Almost all drugs are dangerous, including prescription drugs, which kill hundreds - or thousands - of Canadians a year.
I avoid writing about motives. But why would Ambrose ignore all the evidence and opt for a destructive edict that would hurt people and communities, with no public benefit?
The Conservatives might have answered the question. 
The Conservative party sent out a fundraising letter that echoed Ambrose’s talking points. They were “shocked” to learn Health Canada had approved the heroin trials. “If the NDP or Liberals are elected in 2015, you can bet they would make this heroin for addicts program permanent,” the appeal says. “We can’t let that happen.”
Even though the program reduces the damage done by addiction, makes streets safer and helps individuals and families.
Parties say stupid or dishonest things to raise money and rally support.
But when a health minister and government put politics ahead of both evidence-based policy and human decency, a line has been crossed.
Footnote One: Ambrose’s speechwriters invoked the death of Glee star Cory Monteith in her announcement. Monteith died from a combination of alcohol and heroin use, according to the B.C. Coroner’s Service. Heroin-prescription programs have controls to prevent people who are intoxicated from receiving the drugs.
Footnote Two: B.C. Health Minister Terry Lake said Ambrose was wrong to change the rules and shut down the trial. The idea of prescription heroin isn’t new in the province. In 1994, then chief coroner Vince Cain reviewed the heroin problem. He recommended more treatment facilities, sustained help for recovering addicts and a shift to treating addiction as a health issue, not a criminal one. And he recommended prescribing heroin to people who can’t quit.
Dr. John Millar, then B.C.'s chief medical officer, completed another report on injection drug use in B.C. in 1998. “Heroin in itself is not particularly devastating,'” he found. What does more harm is the struggle to get enough money to buy it, the varying purity and dangerous additives and the sharing of needles.
Millar called for a provincial substance abuse commission to replace the fractured efforts spread across several ministries, an immediate 50-per-cent increase in detox spaces and free methadone. And he too proposed a test of providing legal heroin for those who qualify.