B.C. health provider and patients file lawsuit over prescription heroin access

VANCOUVER – For decades, Larry Love’s daily life was consumed by heroin. Find it. Inject it. Repeat.

That cycle, he said, was broken last year when he enrolled in a radical clinical trial in Vancouver evaluating the use of prescription heroin, seen as the treatment of last resort for severely addicted people for whom other therapy, such as methadone or detox, have failed.

“I just keep looking (for heroin) and receiving — it was a life of hell,” Love, 62, said Wednesday, as he joined other patients in a lawsuit against the federal government demanding continued access to prescription heroin.

“I entered (the clinical trial). My health and well-being improved vastly.”

After he finished his one-year stint in the clinical trial, his doctor applied to Health Canada for special permission to continue prescribing heroin to Love and 20 other patients. The applications were approved.

But the federal health minister responded last month by introducing new regulations to prevent such approvals, insisting Ottawa would not “give illicit drugs to drug addicts.”

Love, four other patients, a legal advocacy group and Providence Health Care are now challenging that decision in court, arguing the updated regulations violate the charter rights of people suffering from severe drug addiction.

The case will once again test the ability of local health officials to pursue harm-reduction policies that appear to run contrary to the federal government’s tough stance against drugs and the people who use them.

The legal arguments in the case are expected to echo those made in favour of Insite, Vancouver’s supervised injection site, which the Supreme Court of Canada prevented the federal government from shutting down two years ago. In fact, the constitutional lawyer behind the Insite case is now representing the prescription heroin patients.

Love is now taking oral medication that his doctors consider less effective for him than heroin prescription.

“We are bringing this legal challenge to save our lives and the lives of others and so we can live normal lives and be productive members of society,” he told a news conference at St. Paul’s Hospital in downtown Vancouver, which is operated by Providence Health Care.

Love was enrolled in a clinical trial known as SALOME, which is comparing the effectiveness of diacetylmorphine — another term for prescription heroin — and an oral pain killer known as hydromorphone for treating severe heroin addiction.

The study operates under a special federal government exemption, which is unaffected by the new federal regulations. However, patients who leave the study after the one-year term are no longer covered by the exemption.

Doctors in Vancouver submitted 36 applications under Health Canada’s special access program, which allows patients to obtain treatments that are otherwise unavailable in this country.

Health Canada approved 21 of those applications, each valid for a period of 90 days, before the health minister stepped in.

Officials with Providence Health Care say it’s not clear whether those 21 patients will still receive the diacetylmorphine for the initial 90-day approval period, but even if they do, they won’t be approved for renewal under the new regulations.

Dr. Scott MacDonald, who is involved in the SALOME trial and submitted the special access program applications, said the federal government’s decision to deny patients prescription heroin is not supported by science.

“As a human being, as a Canadian, as a doctor, I want to be able to offer this treatment to the people who need it,” said MacDonald, his voice quivering with emotion.

“It is effective, it is safe, and it works. …I do not know what they (the federal government) are thinking.”

MacDonald said roughly 10 per cent of heroin users are so severely addicted that they require the prescription diacetylmorphine, which, in the Vancouver study, was dispensed and injected at a health clinic. Of those, about half are able to eventually switch to a less-intense treatment or abstain altogether, he said.

Health Minister Rona Ambrose did not make herself available for an interview Wednesday.

Her spokesman, Michael Bolkenius, issued a written statement that was nearly identical to one Ambrose released last month: “This program was not intended as a way to give illicit drugs to addicts. To keep dangerous drugs like heroin out of Canadian communities, our government has taken action to protect the integrity of the special access program and close this loophole.”

Constitutional lawyer Joseph Arvay said he will be drawing heavily on the legal arguments he used to keep the federal government from shutting down the Insite safe injection site.

In that case, Arvay argued shutting down Insite would violate drug addicts’ rights to life, liberty and security of the person. The Supreme Court of Canada concluded Insite saves lives and the federal health minister’s attempts to close it were “grossly disproportionate.”

“Faced with Insite decision, I don’t know what arguments the federal government will advance,” Arvay said at Wednesday’s news conference.

While the case is currently focused on patients who participated in the Vancouver prescription heroin study, Arvay said it could affect other people with severe heroin addiction, as well.

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