B.C. health officials examine legal options in dispute with Ottawa over prescription heroin

B.C. health-care workers say they intend to fight the federal government over its ban on the prescription of heroin for severely addicted patients.

According to Providence Health Care’s David Byres, revised federal regulations forbidding the prescription of diacetylmorphine (heroin) were made available to B.C. health officials on October 21. The vice president of acute clinical programs told the Straight that Providence lawyers are now reviewing the new rules and examining how they can be challenged.

“We are absolutely not giving up on ensuring our patients have the best treatment available to them,” he said in a telephone interview.

Byrnes was referring to a small group of patients with severe addictions to heroin for whom all other treatment options have failed.

Health Canada approved B.C. doctors’ applications for prescription heroin via the Special Access Program on September 20, 2013. That followed years of research that found that for a select group, prescription heroin is the only treatment effective in reducing the harm certain individuals inflict on themselves through drug abuse.

The doctors showed that a study they conducted from 2005 to 2008 (called NAOMI) and published in the New England Journal of Medicine indicated that heroin can be used safety to help patients that have repeatedly failed with traditional treatments for addiction such as methadone. Similar trials conducted in Germany, England, Switzerland, and the Netherlands have led researchers in those countries to arrive at the same conclusions.

After reviewing that evidence and the advice of its own researchers, Health Canada approved B.C. doctors’ applications to prescribe diacetylmorphine.

Yet on October 2, federal Health Minister Rona Ambrose announced her office had made regulatory changes to forbid the prescription of heroin and other illegal drugs such as cocaine.

Byrnes said that leaves patients struggling with severe addictions with no option but to return to illicit drug markets and the risks that come with them.

“At the moment, they have no effective treatment available,” Byrnes stressed. “We’ve requested a copy of the full regulations, so we’re just waiting for those to be able to examine what they actually say, and then determine what steps we may or may not have.”

Pivot Legal Society has taken on the patients’ case. Scott Bernstein, a lawyer with Pivot, told the Straight that Ambrose’s regulation change is “just the beginning”.

“The federal government really drew a line in the sand here, and I think a lot of people are really concerned and eager to take up that fight,” he said in a telephone interview. “We’re looking at legal avenues; we’re looking at whether we could challenge these regulations as being contrary to the [Canadian] Charter [of Rights and Freedoms].”

Bernstein said that a case for the legal prescription of heroin could resemble the battle that the Conservative government lost to Insite and its operator, PHS Community Services Society. In September 2011, the Supreme Court of Canada dismissed an appeal the feds made in an attempt to shut down Vancouver’s supervised-injection facility.

Ambrose’s decision has also been met with vocal opposition from B.C.’s Health Ministry. On October 4, the Globe and Mail reported that Minister Terry Lake had communicated to his federal counterpart his support for the B.C. doctors’ requests.

“We're reluctant to close the door on innovation and creativity when it comes to tackling these very challenging problems,” Lake was quoted as saying. “I know that the thought of using heroin as a treatment is scary for people, but I think we have to take the emotions out of it and let science inform the discussion. And in this case, I believe this was an exceptional circumstance, compassionate use of a medication to help people transition, and provides information as to treatments that may in fact prove better than alternatives for some people.”

(On October 4, the Straight reported that the province and Ottawa also disagreed on new regulations concerning medicinal marijuana.)

Health Canada did not make a representative available for an interview.

On the phone from a drug policy conference in Colorado, Libby Davies, Opposition critic for health and MP for Vancouver East, told the Straight that Ambrose’s decision was another case of the federal Conservatives basing decisions on politics as opposed to science.

“These applications were approved under SAP [Special Access Program], which means they went through a very rigorous process,” she explained. “Health Canada does not agree to this stuff on a whim. It went through a very rigorous test and criteria. And then what the minister did is she intervened politically and overruled her expert officials. There is absolutely no medical reason for her to have done that.”

Davies, long an ardent support of Insite and harm reduction strategies, emphasized that Ottawa’s regulatory change will have tangible consequences for sick people living in Vancouver.

“That is what I find most alarming: we are not talking about some theoretical situation here, we are talking about real life and death situations,” she said. “We’re talking about people who are really suffering, and to just kick people off because of some political ideology, I find it very cruel.”