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?
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.
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