CMAJ News Health minister ends special access to prescription heroin ealth Minister Rona Ambrose has changed a federal pro- H gram so doctors can no longer prescribe heroin or any other illegal drugs to their patients, despite interna- tional studies indicating that the active ingredient in heroin, diacetylmorphine, is more cost-effective than methadone and improves the lives of long-term users. Ambrose amended Health Canada’s Special Access Programme on Oct. 3 to “more clearly align” it with the National Anti-Drug Strategy and other government programs, the minister told a news conference in Toronto, Ontario. “Our goal must be to take heroin out of the hands of addicts, not put it in their arms,” Ambrose said. Ambrose learned in September, shortly after assuming her new cabinet Canadian Medical Association portfolio, that Health Canada had Health Minister Rona Ambrose amended Health Canada’s Special Access Programme on approved an application from doctors Oct. 3 to “more clearly align” it with the National Anti-Drug Strategy and other govern- affiliated with Providence Health Care ment programs. in British Columbia to provide pre- scription heroin to 21 patients with .1503 /cmaj.110669), researchers from At her news conference, Ambrose long-term addictions. The patients had Providence Health Care used mathe- was flanked by Dr. Meldon Kahan, an previously participated in the Study to matical modelling and data from the associate professor at the University of Assess Longer-term Opioid Medication North American Opiate Medication Ini- Toronto’s Department of Family Medi- Effectiveness (SALOME), a phase II tiative (NAOMI) study to predict that cine, who referred to the use of medical clinical trial. During the study to test patients receiving diacetylmorphine heroin as being among “flawed treat- the effectiveness of hydromorphone would live longer, and societal costs ment approaches.” versus diacetylmorphine, the partici- would decrease, compared with If Ambrose is questioning the sci- pants received diacetylmorphine, the patients taking methadone for mainte- ence behind the NAOMI study, which active ingredient in heroin. nance as part of their heroin addiction international experts have extensively Neither methadone nor repeated treatment strategy. peer-reviewed, she is “barking up the attempts at residential treatment pro- Trials in Switzerland, Germany, the wrong tree,” said Schechter. “By bring- grams has helped the patients, said Dr. Netherlands, Spain and England all ing an expert into a press conference Martin Schechter, a professor at the Uni- found similar results, said Schechter. and criticizing NAOMI, I think she was versity of British Columbia’s School of In each of those countries, after the tri- suggesting she does not have faith in Population and Public Health. “The 21 als concluded, doctors were able to the scientific evidence — when in fact individuals represent people who at the prescribe heroin for the patients who the science is overwhelming.” end of their treatment period were had been enrolled and done well on it, Schechter suggested the federal doing extremely well on the treatment he said. Denmark did not even conduct Conservative government is motivated [diacetylmorphine], and the physicians a trial, but simply acted on the best by ideological factors, rather than sci- at the clinic thought that in the best inter- international evidence to open clinics ence, in making this decision, which he ests of the patients, they should be con- where patients with heroin addictions equated to its attempts to shut down tinued on the treatment,” said Schechter, can receive diacetylmorphine. the supervised injection site InSite in who is also a scientist with Providence “Canada remains the sole country Vancouver, British Columbia. The Health Care. who has studied this scientifically but Supreme Court later overturned the In a study published in CMAJ in then shut the door on its use subsequent federal position on InSite. 2012 (www.cmaj.ca/lookup/doi /10 to the trial,” Schechter said. “I think it has to do with politics and © 2013 Canadian Medical Association or its licensors CMAJ, November 19, 2013, 185(17) E773 News getting elected and playing to your hol overdose in Vancouver to assert that and suggested that doctors wanting to base, but you’d better ask a political heroin addiction is a far-reaching prob- prescribe diacetylmorphine approach scientist rather than me,” Schechter said lem that affects many people. their provincial regulatory colleges. about the government’s motivation in “The prime minister and I do not The changes to the federal program changing the special access provisions. believe we are serving the interests of will not affect clinical trials involving This decision, too, may well be over- those who are addicted to drugs or illegal drugs, such as the SALOME turned, said Schechter, who described those who need our help by giving trial, Ambrose said. The patients cur- his reaction to being unable to prescribe them the very drugs they are addicted rently taking heroin prescribed under what he views as the best treatment for to,” she said. the Special Access Programme will be his patients as “extreme frustration.” The program was never intended to able to continue to until the end of the “I ultimately think this decision will provide heroin to people with addic- 90-day period for which access was be challenged,” he said. tions, but is designed to provide emer- authorized, but their prescriptions will When justifying the changes to the gency access to life-saving drugs, not be renewed. — Laura Eggertson, Special Access Programme, Ambrose Ambrose said. The minister also CMAJ alluded to the death of Canadian actor referred people with addictions to alter- Cory Monteith from a heroin and alco- native treatments such as acupuncture, CMAJ 2013. DOI:10.1503/cmaj.109-4626 E774 CMAJ, November 19, 2013, 185(17).