December 13th, 2013
This haunting question is one of many posed by Dave Murray and other current and former participants in studies on heroin-assisted treatment run in the Downtown Eastside. And it’s led them to the Supreme Court.
Murray was a participant in NAOMI, a study that ran from 2005 to 2008 and showed that heroin-assisted treatment was more effective than conventional methadone therapy for severely dependent opiate users. During the study, participants went to a clinic to receive heroin under medical supervision. They achieved a greater degree of stability in their lives, as they didn’t have to worry about where they were going to get the drug or how they were going to pay for it. They gained more control over their finances, decreased their engagement in illegal activities, and strengthened relationships with friends and family.
But at the end of the study, patients were cut off from the treatment that had brought some steadiness to their lives. Researchers offered only conventional treatments, such as methadone therapy, which had already been shown to be useless for participants. In fact, unresponsiveness to conventional treatments was a criterion for inclusion in the study.
Many former NAOMI participants were forced to turn back to street heroin. For Murray, this marked a period of despondency, as he saw how very unwell people were, but didn’t know what action to take.
He ended up initiating a support and advocacy group for participants, now known as SNAP, the SALOME/NAOMI Association of Patients. SALOME is underway now, and it builds on the findings of NAOMI by comparing heroin-assisted treatment to the use of a licensed pain medication to see if the beneficial results of heroin-assisted treatment can be replicated with a legal drug.
In a way, SALOME seems tangential. After all, numerous studies have shown the efficacy of heroin-assisted treatment, so why not make it available? Why test another drug? In Denmark, instead of running additional studies, the government relied on already established evidence and opted to create permanent treatment programs whereby doctors could prescribe heroin. Yet in Canada the arbitrary distinction between licit and illicit drugs obfuscates vital health initiatives.
SNAP members want continued access to the treatment that improved their lives. NAOMI is the only study of heroin-assisted treatment in the world to cut off patients, and SALOME has no provisions to offer such treatment when the study concludes. With the current federal government, it is impossible to do so.
Last October, after doctors had gotten approval from Health Canada to prescribe heroin to a small number of patients who had left SALOME, Health Minister Rona Ambrose announced that doctors could no longer use heroin and other criminalized drugs in the treatment of addiction. She claimed that illegal drugs “tear families apart, promote criminal behavior, and destroy lives.”
In response, Providence Health Care and five SALOME participants (all SNAP members) have launched a constitutional challenge in the BC Supreme Court. As one SNAP member has put it, “It’s not the drug that fucks us up.” It’s the stigma, the stress of procuring the drug in a climate of prohibition, and the lifestyle that follows, SNAP members agree. They want doctors to have a full toolkit in treating patients, recognizing that what works for one person doesn’t necessarily work for another.
A newly released report, “SNAP: Telling Our Stories, Heroin-Assisted Treatment and Advocacy,” documents what NAOMI and SALOME have given to participants, and how these studies have failed them. SNAP members talk about what coming together has meant for them, and how collectively they finally see a way forward.
“A bunch of fucking junkies got something done,” says one.
To further understand how heroin-assisted treatment is an important part of health care, see Pivot Legal’s “The Case for Heroin-Assisted Treatment in Canada.”