A Letter to Canada’s Minister of Disease?

Dear Rona Ambrose,

As a member of the federal government, you are currently titled Canada’s Health Minister. I question the accuracy of that nomenclature.

You have recently taken it upon yourself to void a decision by Health Canada, the public agency granted the task of supervising health practices in this country. The decision authorized a few physicians in Vancouver to prescribe heroin to a selected number of clients, patients who have failed other treatment attempts to keep their addictive habits manageable. The doctors did not seek such authorization because they wish to promote drug use, but because clinical practice and scientific evidence have shown that the provision of this opiate is beneficial in some cases.

Your reported comments were that there are already safe treatments for heroin addiction, such as methadone, and that there is insufficient proof that heroin is a safe treatment for drug addicts.  I find your statements puzzling at best. There has been no sign that you or your government pay the least attention to scientific data in formulating drug policies. It would be helpful if you were to cite publicly which studies you have consulted, which ones support your position, or how the many that do not may be lacking in scientific acumen, method or objectivity.

For many years I worked as a physician in Vancouver’s Downtown Eastside. I can personally attest that some people simply fail methadone treatment. It does very little for them. Their particular biochemistry does not respond to that synthetic opiate. They still need to keep using heroin. It’s just how it is. I trust you don’t like that. I don’t like it either. I wish it were otherwise, but what you or I may wish is not the issue. The issue is reality.

Here is how a University of British Columbia professor put it who worked on a study published in the New England Journal of Medicine, probably the world’s most prestigious medical publication. “Heroin assistance treatment has a very small, but very important, role in the addiction treatment system,” Dr. Eugenia Oviedo-Joekes said. “It is not meant as a first-line treatment; it is meant to continue the care of people we cannot reach with what is available.” According to European studies, those people may comprise about 10 per cent of the heroin-addicted clientele.

In the absence of medically provided heroin in a safe environment, such unfortunate individuals will continue to seek illegal sources of drugs, potentially impure, and inject them under frequently unsafe circumstances. The resulting illness, overdose, and deaths are surely not outcomes you would desire.

The documented benefits, according to Canadian and international studies include:

  • less crime
  • better employment outcomes
  • improved physical and mental health, increased longevity
  • financial savings to the public purse
  • enhanced life satisfaction and social integration

Given such findings, Minister, your opposition to this Health Canada permission, which you have moved to block, has little to do with insufficient proof. More to the point may be another statement of yours: “This decision is in direct opposition to the government’s anti-drug policy.”

There’s the rub, that policy. In response to the tragedy of addiction, your government has an anti-drug stance. What you do not have is a pro-health strategy. The War on Drugs you and your cabinet mates favour has been proven, numerous times, to be an unrelieved disaster: it kills people, promotes illness, rewards drug trafficking on a massive international scale, ostracizes and marginalizes the most hurt and vulnerable among our population, destroys families and incurs crippling financial costs. And it has utterly failed to curtail drug trafficking and drug use. In recent decades the purity of street drugs has improved while the price has decreased, despite all efforts to interdict their transmission and sale by draconian legal measures and despite greatly increased drug seizures.

“The bottom line is that organized crime’s efforts to succeed in these markets has flourished, and the criminal justice system’s efforts to contain these markets has really been quite remarkably unsuccessful,” Dr. Evan Wood, Canada Research Chair in Inner City Medicine at UBC, has said. “By every metric, the war on drugs has failed.” As Werner Antweiler, a professor of economics at UBC, has pointed out, “The drug problem has not become less, but more.”

Three years ago I, along with an experienced colleague, were invited to Ottawa to address a Senate subcommittee then considering your government’s omnibus “tough on crime, tough on drugs” legislation, since enacted. The senators from your political party endured our testimony with unflinching politeness, listened impassively as we presented fact upon fact about the nature of addiction and the trauma-burdened life histories of addicted human beings, the flaws of drug-war approaches, the retrograde effects of criminalization, the necessity of harm reduction measures such as the provision of opiates to confirmed addicts. Your senatorial party mates spoke afterwards as if they had not heard a word. Nor do you appear to hear any word that questions what you believe. But what you believe personally should not matter when it comes to the health of human beings.

“I want to be crystal clear,” your predecessor as Health Minister, Leona Aglukkaq, said last year. “I do not believe that politicians should pick and choose which drugs get approved.” Perhaps that is why you have replaced her. Nor does your British Columbia counterpart agree with you. “I know that the thought of using heroin as a treatment is scary for people,” B.C. Health Minister Terry Lake has said, “but I think we have to take the emotions out of it and let science inform the discussion.”

There is that word again, “science.” Based on which, your invalidation of this Health Canada decision will have predictable effects: illness, death, suffering.

I know that is not your intention. I’m sure in your heart you wish, as we all do, that addicted people would heal, that drugs would no longer blight the lives of so many. I’m convinced of that. But an objective regard for the facts leads me to this lamentable conclusion: whatever your intentions are, so long as you embrace policies that promote illness, you are in fact serving as Canada’s Minister of Disease.

  • Mona Dyck
    October 15, 2013 at 9:38 PM

    I have had experience in dealing with drug addiction’s consequences and have appreciated the intelligent responses that Dr. Gabor Mate gives when asked to speak at symposiums and to the ‘powers that be’. Why is it that people throughout the world listen and ‘hear’ what Dr. Mate has to say, but our own Canadian politicians think they know better than professionals? Stop the game playing and listen to the professionals. Be proactive!

    • mlawsonTexas
      March 13, 2014 at 7:52 PM

      Mona, It’s a great question as to why leadership has a deaf ear to science and solutions that Gabor talks about. Follow the money. These, so called, leaders can smack down the weak, the ill, the disadvantaged, but let them try to stop the war and those that benefit from the war. Consider that most “wars” have a similarity of enriching a few, at the cost of many. Consider if you will, two-time US medal of Honor winner Smedley Butler and his book “War is a racket”. And don’t stop asking questions….we caused these problems and we can fix’em. M.Lawson di RansomCanyon

    • Lyle Jones
      November 25, 2015 at 9:45 PM

      I myself would write to Canada’s Sole Remaining Noble Class, Who Reign oppressively over The “Triage”, and Lord over the ” DNR”, where dispensation of life or dismissal is at their lordship’s pleasure, alone, by law. Lords all, since a patriarchy has no women, who diagnose by Divine Right, by law, not be evidenced based facts or good reason, but by God, and let no one question their rulings. Our barons whose glorious hands are free what to treat, who to treat, and why to treat, and when to strangle treatment back into the Queens coffers. Not elected but an appointed House of Peers whose judgement is often no more fact based than it is the moral judgement of the gods upon mortal. Questionably educated, reeducated, with a few yes/no reductionist tests they use as tea leaves that indicate as to the compliance and propper breeding of the patient before them. Not positive on the pregnancy test then this uncompliant patient cannot be nauseous as he claims . He is lying or worse. And shame upon his family should they lift a lip in protest. And so the uncooperativr plebean is ruled psychiatric, drug addled, histrionic, malingering, and invalid. based not on the Doctor’s judgement not of medecine, but His self appointed capacity for sociology, urban geography, environmental psychology, family field theory, marginalisation, cultural prejudice, modernity based anthropology and supremacist valuation of human life.

      I would also write to the Gran-noble specialists, whose domain is not only over scuttling servant donkey nurses, “get the meat out of the truck” Anti-Social Workers, and simpering apologist pharmacy fellows, but over the common MD Peer, though the Dermatologist will admit, sometimes, he is ignorant of internal medicine. But still a sociologist ….

      I would write to the Oligarchical College and to the arch-detached Royal College, whose professional development standards and oversight practice are jaundiced by hubris , stiff with archane conservatism, almost void of ethical introsoection, whose arms always have arrow in bow to defend the Holy Right of Certification, from any encroaching discipline that might contest the MD Anti-trust monopoly on Canadian’s access to medicine, services, assistance, re-employmemt, claim to self direction, claim to mental capacity, claim to being worthy enough a human to waste good triage linin on.

      I would write to those who would use “First do no harm” as “first don’t risk your liscence” and then let the meaning in the rest of the oath sink into the mire. I would tell them your time is up. Accountability is soon to come to your door. From new presidents by the courts, by ethical reasoning that grouses those powers accountable, and by a citizenry who begins to follow the money and the disprjdation of authorities to their source.

      You Doctors cannot be our sacred healers and the Police dogs of government. Your overbearing stance and practice expertly makes resistant strains and resistant humans, and one day we will both , all come to claim justice for the power and privaledge we trusted you with and you abused with exclusivity, and even deception . The “Queen” will desert you because she despises the need to print money, the Lt. Gov. In Council will no know you. And you will stand before us, who shall not sleep, while cardinal princes rule in Canadian Medecine.

      • Lyle Jones
        November 26, 2015 at 5:17 AM

        Our medical system is a testament to Poor Fancis’ admonishment, “we try to make caring and healing institutions so as to not shoulder the duty to be caring and healing persons. The dogs are off the liesh because each of us has watched a health care atrocity and not done the right thing as per our own conscience. You can’t put a human institution on wheels, not monitor the road the driver or the structure and expect it to be serving life when you check again in 10 years. We cannot abdicate out duty to conscience to authority so easily and we must be good persons to form good institutions. And to keep them good.

  • msmely
    October 15, 2013 at 10:11 PM

    It’s too bad that appealing to scientific evidence has historically been unsuccessful when it comes to trying to influence the decisions of the Harper government. See also: climate change. When the science disagrees with their ideology, they try to erase the science. It’s sickening.

    • mlawsonTexas
      March 13, 2014 at 7:58 PM

      Msmely,
      As a follower of Phillip Zimbardo (5 steps to tyranny), I believe an early tenant of his. If I understand it right; We have to use the same methods that degraded humanity to elevate humanity. In free societies we cannot control people by force, so we have to appeal to their reptilian brain, the part that is controlled by emotion, rather than objective critical thinking. IMHO. M. Lawson di Ransom Canyon

    • Cynthia
      November 30, 2015 at 4:25 PM

      If you’re struggling with sugar addiction, and I could say anything to you it would be this: It’s not your fault. Let me say it again: It’s not your fault. And again, with tears in my eyes: it’s not your fault. You are innocent. Sugar addiction is not about will power or character flaws. It’s not something that you’re consciously choosing. If you struggle with sugar, your sweet, sweet brain and body is simply looking for a way out – for a way to care for pain that feels too much to bear. Why addiction is not your fault. Period. Karly Randolph Pitman

  • Cheryl Eskra
    October 15, 2013 at 10:55 PM

    This letter hits right to the point. I agree with it and support its message most fully and completely. Thank you Dr. Mate!

  • Paula Kinghorn
    October 15, 2013 at 11:13 PM

    Dr. Mate has an understanding of the disease of addiction usually only found in an addict. I am an addict. I have been clean for five years. In my short history of being clean & sober, I have discovered that people are very fearful when talking about addiction. They are victim to their own fear, prejudices and ignorance. The war on drugs fails to address the real problems in our society and the result is that addicts (and alcoholics) are not treated as “sick” people. If it is, in fact, a disease…why do we not treat addicts with the compassion and caring that we treat people afflicted with other diseases? Addicts are punished in our society. The doctors who support and advocate for compassionate care for addicts are disregarded. If decisions in politics are made based not on facts and evidence but instead on the fears of the individuals in power, we will continue to do more harm than good to those in dire need of help.

    • mlawsonTexas
      March 13, 2014 at 8:08 PM

      My dear Ms. Kinghorn,
      Another great question; Why do we treat people differently with different disease processes. Proactive Communication Models. Look what we’ve done with teen smoking, breast self exam and Ted.com (in jest). We have chipped away at so many prejudicial aspects of our species. From color, to gender, to tribe and religious beliefs. We live in great times where folks like Gabor can reach out and find thousands of like minds, and with our collective might NOT loose the name of Action. Sincerely,
      Mark di Ransom Canyon

    • Kemtong
      November 30, 2015 at 5:08 PM

      Oh, these are just gorgeous, they relaly made me smile for some reason!LOVE love love the model in black on the giant swan….please let that be me!!Great colour and light in all the pics too :)Hope your computer issues are all sorted Ms Deej! xx

  • Pauline Byrne
    October 15, 2013 at 11:37 PM

    As usual, you make your points with scientific proof, and with clarity. Well done and well said. Pray they listen to you

  • Michele Brandt
    October 15, 2013 at 11:39 PM

    Applause, applause Gabor!
    “Many a person thinks he or she has an open mind, when it is merely vacant.”
    unattributed

    • mlawsonTexas
      March 13, 2014 at 8:15 PM

      Michele,
      Great quote, I can’t find an author either. But our job, if we decide to accept it, is to “nudge” that vacant mind into self realization of truth and my favorite Scientific Machine doing that is: Carl Sagen’s Baloney Detection Kit. And like our secret order that “strikes at the devil at every chance” strike at those that use illogical argument, ad-hominum attacks, etc. Pax vobiscum Lawson

  • Danny J Albers
    December 15, 2013 at 1:53 PM

    I quite often have difficult in seperating “the political right or left” from the other forms of religion.

    The Harper government has made its disdain for science, and in fact “facts in general” quite clear.

    No point in lousing up good political sermons to the choir with “facts and research”.

    Two places in Canada nobody wants to hear from a scientist? Church and the House of Commons (At least on the governing side). Seems true honestly no matter who is in charge by the current “Neo Con” movement is actually proud of their pursuit of blind ignorance, their faith in the “vision”.

    Its also pretty hard to dissaude a government from any policy that will turn patients into criminals when we have a for profit privatized penal system in the works with lobbying money available.

  • Hillary
    January 16, 2014 at 3:49 PM

    Absolutely! It seems to ‘let liquor off the hook’… something the booze industry probably appreciates (and no, I’m not suggesting any kind of conspiracy theory). Jon Stewart has a wonderful segment (recently aired) where he shows folks on Fox news(?) ranting about legal pot in Colorado, interspersed with their segments about wine, boozing it up, yee-haw. The hypocrisy is not intentional, I’m sure. So… what can we do to alter the perception? P.S. Dr. Mate, you’re brilliant. Thanks!

  • Alec Scoones
    January 23, 2014 at 2:40 AM

    Thank you Dr. Mate.
    Would that your thoughtful comments were to find ears that could hear in Ottawa

  • John Arthur
    January 23, 2014 at 12:52 PM

    A very useful summary of what most of us who are involved in working in this area know already. That in terms of failed public policy, never has there been one that has so spectacularly failed in every country it has been tried, and yet continues to be rolled out against the evidence of ineffectiveness and so utterly devastates people’s lives as that of drug prohibition.
    Now in recovery for 18 years I have lost so many family and freinds, lived in areas where the life expectancy is akin to some of the poorest developing countries as a result of addiction and our poor response to it, spoken as Dr Mate has at parliaments, international conferences and with senior academics and policy makers who all seem to agree (off the record) but who never seem to back sensible legislation.
    I said in the Scottish Parliament that until we have politicians with the ‘cajonhes’ to stand up for what is right on this matter we will continue to have laws which harm more than they protect. (American cinematic influences on my otherwise celtic brogue)

    I’ve worked it out that as citizens we need to continually feed back to our elected representatives that they need to think differently, to our civil servants that they need to try to draft policies that are evidence based and challenge news outlets that promote distorted views of addiction.
    all the best
    John

  • Chris
    January 27, 2014 at 3:18 PM

    It seems to me that politicians will do their utmost to avoid the facts, they operate on beliefs and this is why the planet is in such a mess. It does make me wonder whether the aim is to encourage crime but to spend as much as possible of the world’s debt based money without actually doing anything to solve the real problems we are facing. Perhaps it is the politician’s real masters, the international banks, who actually design such ridiculous policies and they simply relay them to the suffering public. Perhaps, there is more money in keeping things the way they are!

  • mlawsonTexas
    March 13, 2014 at 8:23 PM

    Dear Gabor:
    Happy birthday to Aaron. I just wanted to say what a wonderfully constructed appeal for reason. Just the right amount of bite and truth to make one act. Have you heard a response?
    Sincere Like Mind,
    Mark Lawson di Ransom Canyon

  • Aimee
    April 23, 2014 at 6:48 AM

    Please keep writing for this blog, Dr. Mate! I was looking for your blog about a year ago and it wasn’t here yet, and now I look again, and you have one!
    Thank you so much!!!!!! For these wonderful books you’ve written. There is much work to be done. I’m looking forward to continuing to help our society understand trauma better and the effects it has on us. You’ve made this journey so much easier! Thank you again.

  • Kerry Pay
    May 19, 2014 at 1:38 AM

    Thank you Gabor for educating me! Humans are so smart and yet some can be so stupid when presented with the facts. They still insists on clinging to their purely emotional feelings and disregard the facts that are set before them. I never took any kind of drug because I knew the brain had chemicals within which the drug would interfere; therefore, I did not wish to disturb these chemicals within. In the 60’s we were taught in health classes not to mess with mother nature’s brain chemicals. Thus do not put things into your body that would cause a chemical imbalance to occur.
    Stop the prejudices against chemical addicts who only strive to stop the pain caused by adults onto children, thus causing the children’s brain chemicals not to function as they should if we had retained our tribal ways as the human brain evolved itself over generations and generation.

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