Tuesday, November 12, 2013

Gabor Mate on Drug Abuse

Science has never supported prohibition.  That is a policing concept that naturally produces artificial product scarcity and the necessary criminal delivery system.  Technically, we can do the same thing for any difficult to supply consumer product.  What is offensive is that science and medicine is coopted to go along.

At the same time, the police enjoy a strong public constituency that is difficult to challenge politically.  It is a career ender or at least it has been.  The press worsens it all by leaping at the chance to destroy such public careers.

Are the politicians really this dumb?  Hell no, they just like their jobs.  It is way easier to go along than to try to change it. 

In the meantime, the reformers are radicalized but then aimed at the politicians were they do not really bother anyone.

Drug reform requires a major intervention.

1                    Mandate a completely new protocol for managing all drug abuse.  This must include tobacco and alcohol.  This at least divides the special interests and their constituencies and ensures almost everyone has a stake in the outcome. 
2                    Mandate all abuse as a medical issue and depending on risk and severity, various levels of medical supervision.  This will range from a below the threshold usage level to an actual withdrawal of personal freedom for an out of control addict that poses real danger to himself and others.  It all stops been criminal.

An excellent example is alcohol driven violence.   Such a person should be immediately ordered to attend a two week tree planting project in a completely dry camp to meditate on his unacceptable behavior.  It may not work but it will certainly get trees planted and sooner or later the individual may actually decide he can take better care of himself.

Better yet, quick justice of this type teaches all his social circle that discipline is a good thing and they all learn to manage the usage far better.
You will notice that I have not mentioned any of the other drugs yet. The reason is that unless we tackle drug abuse generally we will never solve it.  Solve it for the acceptable ones and simply legalizing the rest then works by collapsing their markets with cheap product under managed distribution usually requiring a prescription given out only to established addicts.  The process becomes managed on the basis of scientific harm and benefit but not through any form of black market.

Such a regime would give grass an easier ride than alcohol for example but be strictly prohibited for medical reasons to minors.

Gabor Maté: A letter to Rona Ambrose, Canada’s "minister of disease"?

by GABOR MATÉ on OCT 23, 2013 at 11:15 AM

Health Minister Rona Ambrose visited the University of Alberta to demonstrate an interest in science, but her government rejects experts’ advice on drug addiction.

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 who worked on a study published in the New England Journal of Medicine, probably the world’s most prestigious medical publication, put it: “Heroin assistance treatment has a very small, but very important, role in the addiction treatment system,” Dr. Eugenia Oviedo-Joekes told a Globe and Mail reporter recently. “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 be about 10 percent 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 antidrug policy.”

There’s the rub, that policy. In response to the tragedy of addiction, your government has an antidrug 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 have really been quite remarkably unsuccessful,” Dr. Evan Wood, Canada Research Chair in inner-city medicine at UBC, told Canadian Press on September 13. “By every metric, the war on drugs has failed.” As Werner Antweiler, a professor of economics at UBC, pointed out in that same article, “The drug problem has not become less, but more.”

Three years ago, an experienced colleague and I 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 words that question 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.

Dr. Gabor Maté is the author of several books, including In the Realm of Hungry Ghosts: Close Encounters With Addiction. This article first appeared on his blog at drgabormate.com/blog/.


Paula Pothier
OCT 24, 2013 at 7:15 AM
Deeply angers and saddens me to see how much clout and decision-making power these political ignoramuses (that are elected by "the people") are allowed to wield. Ambrose's unwillingness to listen to scientific evidence and her resulting head-in-the-sand policy that has such dire consequences for so many people on so many levels, is sickening. It saddens me further to realize that even if she read Dr Maté's book: In the Realm of Hungry Ghosts, she probably still wouldn't get it...such is the disease of political power gone bad. Perhaps the only thing that would change her mind is having a direct and lived experience being and working with people with addiction. Too bad we can't make 'job shadows' (read 'reality checks') mandatory for these myopic public officials.

2x2 project
OCT 24, 2013 at 5:14 PM
Pls read our open letter to Ms. Ambrose in support of heroin addiction treatment with DAM
Pls RT our open letter to Ambrose for #heroin #addiction #therapy 

OCT 24, 2013 at 9:31 PM
"Hungry Ghosts" is such a first rate book that any politician at any level would benefit from reading it, esp. a federal minister of health. But one suspects the current government has other issues to deal with at the moment, sadly of their own making. Which is the real insult to Canadian taxpayers isn't it? Instead of doing their jobs, because of incompetence and avarice, they're spending their time, paid for by us, in what looks a lot like trying to save their jobs.

OCT 24, 2013 at 10:10 PM
Bravo Dr. Mate! You tell it like it is.

OCT 24, 2013 at 10:10 PM
Superb letter

OCT 25, 2013 at 3:35 AM

Before you can comment on failed enforcement tactics I think you should post how many criminal drug investigations you have personally been part of. I have no issues with a doctor prescribing heroin to a patient if it is going to show positive manageable results. I say this because I am not a doctor and don't have the same training as you. Just a you are not a law enforcement professional and don't have the same training as I do when it comes to the so called war on drugs. There are many reasons that the drug trade in this country has skyrocketed and many of those have to do with the complete lack of commitment to enforce the law by our justice system. As to the quality and availability of drugs, that speaks directly to innovation and lower cost of production on the part of the producers and traffickers of these drugs. I support your comments on politicians keeping quiet on medical treatments but I also say doctors shouldn't have a say in how law enforcement gets done either. You heal em I'll protect em.

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