Pubdate: Thu, 29 May 2014
Source: Georgia Straight, The (CN BC)
Copyright: 2014 The Georgia Straight
Author: Travis Lupick
Referenced: Chief Justice Christopher Hinkson's judgment:


THE B.C. SUPREME Court has granted an injunction that lets doctors 
give prescription heroin to select patients in Vancouver.

According to a 34-page decision, Chief Justice Christopher Hinkson 
found that risks faced by the opiate addicts acting as plaintiffs in 
the case would be reduced if doctors were allowed to administer 
diacetylmorphine (prescription heroin).

"I accept that the potential harms facing the personal plaintiffs, 
and those on whose behalf they apply, are grave and that an award of 
damages will be of little, if any, assistance to them," Hinkson 
wrote. "As such, those harms must weigh heavily in the balance, 
particularly given that the exemption requested by the applicants 
does not cause any material harm to the government pending the 
ultimate resolution of this matter at trial."

Vancouver doctors previously secured the necessary permissions under 
the federal Special Access Programme (SAP) to prescribe heroin to a 
specific group of patients who had repeatedly failed with other 
available treatments for opiate addiction. But in October 2013, 
Health Minister Rona Ambrose amended regulations to close what she 
described as a "loophole", barring clinicians from administering 
drugs such as heroin, cocaine, and ecstasy (MDMA).

The case entered the courts on March 25, 2014, when Providence Health 
Care and five long-time opiate users appeared in B.C. Supreme Court 
in an effort to secure diacetylmorphine as a legal means of managing 
addiction. I t concerns past and present participants in the Study to 
Assess Longer-term Opioid Medication Effectiveness ( SALOME ), which 
remains underway at Providence Crosstown Clinic in the Downtown Eastside.

The plaintiffs mounted a constitutional challenge, arguing that 
participants' right to access evidence-based treatment under the 
Canadian Charter of Rights and Freedoms had been impeded. They are 
represented by Joe Arvay , who was instrumental in Insite's 2011 
victory in the Supreme Court of Canada, and lawyers with Pivot Legal Society.

According to Hinkson's May 29 decision, the court has granted an 
interlocutory injunction that provides for the approval of "all 
outstanding plaintiff requests and future SALOME requests for access 
to  diacetylmorphine". It's noted that to be eligible, patients must 
have a record of failing to respond to other available treatments for 
opiate addiction (such as methadone), and that they must be 
represented by a physician who has made a SAP application on their behalf.

In a telephone interview, Pivot's Adrienne Smith described the 
court's decision as "a victory for evidence-based medicine".

"It gives hope to other heroin users who may benefit from this 
important medication," she said.

However, Smith noted that while an interlocutory injunction has been 
granted, the judge denied Providence's request for a mandatory 
injunction that would have directed regulators to take steps 
necessary to ensure there is a supply of diacetylmorphine adequate to 
meet patients' needs. She said this leaves the matter susceptible to 
Health Canada "proceeding in good faith".

With an injunction secured, Smith continued, the next step is to see 
Providence's constitutional challenge enter the courts.

"We're anticipating that could take a year, which is disappointing," 
she said. "The good news is that this decision will keep our clients 
safe during that year. I'm hopeful and our clients are hopeful."

In a March 2014 telephone interview, David Byres , vice-president of 
acute clinical programs at Providence, explained that a study similar 
to SALOME called NAOMI (North American Opiate Medication Initiative), 
conducted from 2005 to 2008, found that in certain cases, 
heroin-assisted therapy proved more effective than methadone in 
improving the wellbeing of long-time opiate addicts. Those results 
were published in the New England Journal of Medicine in 2009 and are 
supported by similar academic findings in Denmark, Germany, 
Switzerland, and the United Kingdom.

"The NAOMI trial provided definitive evidence that diacetylmorphine 
is an effective treatment," he said.

Affidavits drafted by the five opiate users participating in the case 
emphasize the struggles involved in maintaining the steady supply of 
drugs required by heavy addictions. The documents explain how heroin 
administered on a prescribed basis alleviates the harm users inflict 
on themselves and society.

"I spent my money on food and vitamins rather than drugs, and I 
became healthier," Charles English wrote. "While on the study, I 
exercised regularly and took care of myself. I did not commit any 
crime to support my drug habit. I took showers, wore clean clothes, 
and was a functional member of society."

The Straight has repeatedly attempted to learn how the federal 
government arrived at its position against the administration of 
diacetylmorphine, which contradicts a growing body of scientific 
evidence. Despite Health Minister Rona Ambrose personally assuring 
the Straight that that information would be supplied, Health Canada 
has not provided anything specific in the way of academic studies or 
the opinions of experts.

In response to the court's May 29 decision, Health Canada sent an 
email to media in which it's stated the federal government is 
considering its option.

"We will continue to support drug treatment and recovery programs 
that work to get Canadians off drugs in a safe way," the email reads.

Acting on behalf of Health Canada, the Attorney General now has the 
option of appealing the judge's decision.
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