Joseph Arvay, the lawyer representing five heroin addicts, told a judge the four men and one woman were part of a clinical trial that provided them with pharmaceutical-grade heroin until last year. When they left the study, with the recommendation of their doctors, they applied for — and were granted — special access permits from Health Canada to receive the prescription drug, diacetylmorphine.
Federal Health Minister Rona Ambrose responded by announcing immediate changes to prevent Health Canada from approving prescription heroin under the program.
"The health minister comes out in a press release and essentially saying 'over my dead body,'" Arvay told B.C. Supreme Court Judge Christopher Hinkson.
"The regulation that flowed from that obviously was not done on the basis of any pre-existing research or science. This was just the government responding in a very kneejerk reaction."
Heroin addiction is a chronic disease which, left untreated, can be fatal, he told the judge.
"We are dealing with the hardest of the hard to treat," Arvay said.
His clients all took part in clinical trials conducted by Providence Health Care.
The first, the North American Opiate Medication Initiative, or NAOMI, took place in Vancouver and Montreal from March 2005 to July 2008. The blind study compared the effectiveness of pharmaceutical-grade heroin, known as diacetylmorphine, and oral methadone. Two of the plaintiffs were NAOMI participants.
The second, the Study to Assess Longer-term Opioid Medication Effectiveness, or SALOME, began in 2011. The study is comparing the effectiveness of hydromorphone, a synthetic drug approved for use to control pain, and pharmaceutical heroin in treating severe addiction. All five plaintiffs took part, exiting the program last year.
All five were among 21 people approved by Health Canada for pharmaceutical heroin after leaving the study, but none received any after Ambrose introduced the amendments to bar heroin, cocaine and ecstasy from the program.
Ambrose issued a written statement Tuesday that repeated many of her previous arguments against providing prescription heroin to addicts. She said Health Canada staff granted the approvals through a loophole that needed to be closed.
"Heroin is a dangerous drug that destroys lives," the statement said.
"Our opponents argue that a small percentage of drug addicts cannot be treated and the only course of action is to provide them with legal access to their addiction. Our government will not give up on people who are addicted to drugs; we will continue to advocate for safe treatments and recovery instead of feeding the addiction with heroin itself."
In court, Arvay told the judge the federal government made the same arguments against medical marijuana before the courts forced legalization of the drug for medicinal use.
Depriving these chronic addicts of effective treatment is a violation of their charter rights, he said.
"Instead of being in treatment with doctors administering safe heroin, they will be back in the alleys of the Downtown Eastside injecting illicit heroin, with all of the problems — indeed horrors — that entails."
The federal government is also infringing on provincial jurisdiction over health-care by removing the treatment option of prescribed heroin, Arvay argued. The plaintiffs have the support of the B.C. government, Providence Health Care and the PIVOT Legal Society, which advocates for people in the city's impoverished Downtown Eastside.
Arvay asked the judge to essentially force Health Canada to abide by the former rules until the case is heard.
The federal government is expected to present its argument to the judge on Wednesday. In court documents, lawyers for the federal government argued the special access program was not meant to operate as an alternative to clinical trials or comprehensive drug reviews.
It is meant for short-term access for emergency needs only, the documents said.
"Heroin is not approved for sale in Canada as a drug for the treatment of heroin addiction," the documents said. "The potential use of heroin as a treatment for heroin addiction is still in the investigational stage and even the medical data collected to date is far from conclusive in all relevant respects."
There are a number of medically approved treatments for heroin addiction available, government lawyers contend.
Outside the court, Douglas King, a staff lawyer for PIVOT, said the 21 people who initially received approval and other clinical trial alumni are now without prescription heroin.
"In any other kind of a trial — in a cancer trial ... nicotine treatment — we would never cut somebody off if it were found to be effective," he said.
Federal opposition to harm reduction is ideological, he said.
"Generally, we have a federal government that is enacting policies that are not based on the current case law or the current medical recommendations in the medical community."
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