When good science meets the Harper Administration

Late last week Rona Ambrose, Canada’s Health Minister, announced a new regulation that would deny clinical treatment of diacetylmorphine for heroin addicts (Vancouver Metro, October 4-6, 2013; Vancouver Sun, October 5, 2013). The news comes in stark contradiction that this treatment is more effective for certain types of addicts than the currently widely accepted methadone treatment, “[p]rescribed, supervised use of diacetylmorphine appears to be a safe and effective adjunctive treatment for this severely affected population of patients who would otherwise remain outside the health care system” (Oviedo-Joekes, et al., 786). According the North American Opiate Medication Initiative (NAOMI), a randomized control trial that evaluates the feasibility and effectiveness of heroin-assisted treatment in Canada (Oviedo-Joekes, et al., 2008), not only were patients on this treatment less likely to relapse but their lifetime cost of health care and criminal  justice system were also reduced. We also have several former addicts who are speaking out to tell their personal stories of success. When medically supervised this treatment works, and in turn may lead to lower overall costs to Canadian society through lowered health and justice costs.  When the government is looking to cut costs why are they discounting good science that is showing cost-saving opportunities?

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Picture reference: http://nextyearcountrynews.blogspot.ca/2011/08/making-sense-of-federal-election-in.html

Is this an example of failed knowledge translation, “[t]his means that patients are denied treatment of proven benefit because the time it takes for research to become incorporated into practice is unacceptably long” (Graham et al., 13). Graham et al. (2006) critiques the time required to show positive research results and transfer that into positive outcomes for patients. In the diacetylmorphine example, the translation is interrupted by not only the acceptability to practice but the interference of the Harper administration in a treatment for which they are disregarding because of a public relations boost and marginalization of a population who probably will not be targeted in his upcoming re-election bid. However to those Canadians who are paying attention – don’t we need to provide the best quality care whilst reducing the financial burden on our public systems.

Caplan (1979) discusses the two-communities theory which explores the gap between academia and the political realm. The “the spectre of knowledge misuse by political power tends to widen the gap” (459) between communities. Many times this divide leaves researchers wondering how or when their finding will ever be applied in the real world. Looking specifically at the example above, despite the research, despite the pleas of practitioners, the government unilaterally will act within the power of the crown. Is this really an example of lack of information, or the lack of knowledge translation to Rona Ambrose? Perhaps this gap that exists between our two communities needs to be explored. There needs to be more than a transfer of information, perhaps a personal relationship with the people that this government is apparently leading is required.

References

Caplan, N. (1979). The two-communities theory and knowledge utilization. American Behavioral Scientist, 22 (3), 459-470.

Graham, I., Logan, J., Harrison, M., Straus, S.,Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: Time for a map? The Journal of Continuing Education in the Health Professions, 26 (1), 13-24. DOI: 10.1002/chp.47

Jackson, E.(October 3, 2013). Health Minister Rona Ambrose’s heroin ban ‘ignores science’. Metro Vancouver. Retrieved from: http://metronews.ca/news/vancouver/814664/health-minister-rona-ambroses-heroin-ban-ignores-science/

Oviedo-Joekes, E., Brisette, S., Marsh, D., Lauzon, P., Guh, D., Anis, A., & Schechter, M. (2009). Diacetylmorphinr versus methadone for the treatment of opioid addiction. The New England Journal of Medicine, 361 (8), 777-786.

Oviedo-Joekes, E., Nosyk, B., Brissette, S., Chettiar, J., Schneeberger, P., Marsh, D., Krausz, M., Anis, A. & Schecter, M. (2008. The North American Opiate Medication Initiative (NAOMI): Profile of participants in North America’s first trial of heroin-assisted treatment. Journal of Urban Health, 85 (6), 812-825.

Robinson, M., & O’Neil, P. (October 5, 2013). B.C. Clashes with Ottawa over heroin research. The Vancouver Sun. Retrieved from: http://www.vancouversun.com/clashes+with+Ottawa+over+heroin+research/9001727/story.html

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One response to “When good science meets the Harper Administration”

  1. lili891 says :

    The failure of knowledge translation and the widening gap between researchers and policymakers are never so evident as in the Harper government’s adamant refusal to accept harm reduction measures that have demonstrated effectiveness (e.g., injectable diacetylmorphine, supervised injection and other drug consumption facilities, etc.). The significance of this failure and divide becomes more pertinent given the situation in which participants find themselves once study goals are met and support systems are withdrawn.

    Canadian Health Minister Rona Ambrose’s announcement of the federal government’s ban on prescribing unconventional illicit drugs (e.g., heroin, cocaine, LSD) to treat addiction would not affect those already undertaking this treatment. However, this raises the important issue of whether there are sufficient supports for those undertaking such treatments for addiction as opioid substitution therapy. Participants trade in one addiction for another only to have not only their medication, but also the support systems they have possibly come to rely on, withdrawn. The lack of support systems for participants taking part in studies concerned with evaluating ‘drugs’ is a pervasive issue that absolutely cannot be neglected. Experiences in the public health field have shown that this occurrence is by no means rare.

    The federal government’s refusal to entertain cost-effective and potentially groundbreaking science is surprising. As mentioned elsewhere, perhaps what is lacking in this equation is a trusted source to mediate between researchers and policymakers. The potential for the knowledge broker role is extensive, and could be the first step toward not only the creation of a mutual trust between researchers and policymakers, but also the recognition and appropriate use of scientific evidence in policy.

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