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Prescription heroin case going to Supreme Court

Health Canada authorized doctors to prescribe heroin to addicts exiting a clinical trial, but the federal Health Minister made it illegal.

JOHN LEHMANN/GLOBE AND MAIL

A battle between B.C. doctors and the federal government over the prescription of heroin to severely addicted users is set to enter Supreme Court.

Last fall, Health Canada authorized B.C. doctors to prescribe diacetylmorphine (heroin) to 21 severe heroin addicts exiting a groundbreaking clinical trial, but federal Health Minister Rona Ambrose swiftly introduced new regulations that would make doing so illegal. Providence Health Care and five addicts represented by the Pivot Legal Society launched a constitutional challenge and, in the meantime, are seeking an injunction so the addicts can receive prescription heroin while the case is before the courts.

"What we're asking for is that a decision on this be made based on evidence, and not ideology," said Pivot lawyer Doug King. The hearing is expected to run Tuesday to Thursday in B.C. Supreme Court.

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In 2005, researchers at Providence Health Care and UBC launched a three-year heroin study called the North American Opiate Medication Initiative (NAOMI). They found that entrenched addicts who received prescription heroin in a supervised, medical setting experienced more physical and mental-health improvements. The addicts also were more likely to stay in treatment and reduce illegal drug use and criminal activity than those on methadone. An ongoing follow-up study launched in 2011, called the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), has yielded the same results.

"While [in the follow-up study], I became more involved in being a community organizer and became more engaged in goal-setting and building relationships with people in the community," wrote David Murray, a user of more than 40 years, in an affidavit in support of the injunction.

Doctors submitted applications to Health Canada's Special Access Program (SAP), which grants doctors access to non-marketed or otherwise unapproved drugs for patients with serious or life-threatening conditions, to prescribe heroin to dozens of addicts exiting the follow-up study. After consulting with an independent addictions specialist, the department approved 21.

Immediately, Ms. Ambrose denounced her department's decision and moved to ensure it would never happen again. On Oct. 3, she introduced new regulations that banned doctors from prescribing "dangerous drugs like heroin, cocaine, ecstasy and LSD and abusing the SAP." Critics slammed Ms. Ambrose's decisions as being based on political ideology.

Providence, represented by lawyer Joe Arvay, and the five plaintiffs launched a constitutional challenge, arguing that denying the drug is a violation of the addicts' rights to life, liberty and security of the person under Section 7 of the Charter. The urgency of that case will depend on the outcome of this week's injunction hearing.

Questioned by The Globe and Mail on the matter at an unrelated event in Vancouver last week, Ms. Ambrose said she will "continue to advocate for treatment and recovery" over "feeding the addiction with heroin itself."

When presented with the argument that prescription heroin is a second-line treatment, meant only for the small subsection of addicts who have failed repeatedly at conventional therapies, Ms. Ambrose said she does not believe in a "throwaway society."

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"I hope that they don't think that the health minister of Canada would think that there are people we should just discount because treatment hasn't worked for them on a number of occasions," she said.

"Regardless of how small of a percentage of those people there are out there, I want them to seek … a treatment for their heroin addiction that is safe."

Ms. Ambrose said there are scientists, researchers and clinicians with decades of experience in addictions who support her decision. The Globe and Mail has requested any reports reviewed, or doctors consulted, in advance of Ms. Ambrose making her decision but has not received a response.

Meanwhile, the 21 addicts already approved for prescription heroin – whose three-month approvals were not supposed to be affected by the new regulations – have still not received their heroin.

Follow me on Twitter: @AndreaWoo

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