"How can a campaign to legalize this humanitarian painkiller be successfully conducted in the U.S.?" asks Canadian Ken Walker, a leader in his country's battle to medicalize heroin. His experiences both before and after his formation of the W. Gifford-Jones Foundation have led him to conclude, "It's not an easy task."

Soon after Dr. Walker began his quest to free heroin for use as medicine he found himself combating The Cana-dian Cancer Society, The Canadian Society of Hospital Pharmacists and, as a doctor and medical journalist, many of his own colleagues. In January of 1979 Walker wrote a "New Year's Reso-lution" syndicated column, which ap-peared in 65 Canadian newspapers. The doctor explained that heroin was more effective than morphine as a pain-killer and cited as an example its use in England for over 80 years. His call for the release of the narcotic ban on her-oin 'Struck a sensitive note. "Ninety-nine percent of the readers damned a law that kept the option of this pain-killer from their dying loved ones," Walker recalls.

But to his surprise, "The very people I thought would applaud the column, damned it." The Canadian Cancer Society reacted immediately, charging, "There is no supportive evi-dence that heroin has any unique prop-erties. Heroin is not needed if existing drugs are used correctly."

Medical council investigates

Meanwhile, another forceful reformer, Dr. William Ghent of Kingston , Ontario, led the Canadian Medical Association Council on Health Care in a three-year examination of the his-torical record. The report revealed how deception had permeated the Cana-dian decision in 1954 to ban heroin totally in medicine, a submission to U.S. pressure on the World Health Organization and other international health groups. The CMA rejected the idea of prohibition because heroin was better than morphine in some cases and also because the U.S. experience had shown that absolute prohibition had not curbed street abuse. However, when, in 1954, the matter came up before the House of Commons, govern-ment ministers misled the assembly. The legislators were given the impres-sion that the organized physicans of the country supported prohibition. One official stated on the floor of the House, "We discussed it with the Canadian Medical Association," but neglected to mention the fact that the CMA advice had been against prohibition.

Thirty years later, Dr. Ghent said, while presenting a resolution to medi-calize heroin at the CMA annual meet-ing: "We followed the U.S. like sheep and now, like sheep, we've got their manure to deal with."

Addiction worries fuel criticism

The worry that addiction is a guaranteed consequence ofheroin treat-ment is the unifying force behind oppo-nents of its medicalization. Dr. Walker has encountered what he terms a "dinosaur mentality" among the bureaucratic organizations he has locked horns with for nine years.

His search for truth regarding the use ofheroin as a painkiller led him to a pain specialist at the St. Thomas Hospital, London, who offered this comment: "I have patients on large doses of heroin who can still go out shopping. Tell North Americans to stop worrying about addiction. I can wean patients offheroin in two weeks if there is a remission in the disease. Addiction occurs when drugs are taken for pleas-ure. But when prescribed for pain the pain eats up the addictive qualities of heroin."

"Critics then claimed that heroin was not needed because it was the same as morphine," Walker points out. He agrees that heroin does break down into morphine in the body, but he adds, "ifyou hold ice and water in your hands, both with the same properties, the body will react differently."

Walker describes the critics' in-sistence that the British medical estab-lishment has switched from heroin to morphine as a "great fabrication." He recently visited St. Christopher's Hos-pice in London, the prime example of the switch used by critics, and was informed by the nursing staff late one evening that while doctors did prescribe oral morphine, "80 percent of the pa-tients received intramuscular injections of heroin in the final days or hours of life." One pain specialist in London told Dr. Walker, "They made a big mistake at St. Christopher's. They should have made it clear to the world that heroin is still the best narcotic for injections."

Walker recalls a visit to the Great Ormond Street Hospital for Sick Chil-dren. "Doctors told me heroin was always their drug of choice. Children, they stressed, react better to heroin. It makes them feel `fuzzy' when severe pain is present. And they often send children home on heroin."

But the "old boy network" was also operative in England, Dr. Walker discovered. "I listened an hour while one of England's top pain specialists preached the virtues of heroin. But he refused my invitation to visit Canada and tell others what he had told me. He was aware that some members of the Canadian government were opposed to the use of heroin. He often met these colleagues at international meetings and did not want to offend them."

Heroin critics, Walker explains, had yet another argument, "they claimed security of supply constitute a major problem and threat to medical personnel." Walker is confident that his readers would not accept this argu-ment when their loved ones were in pain. "Security is a law enforcement problem, not a medical one," he rebuts, and adds that "security is no reason to deny heroin to the dying."

In July 1982, Walker presented a brief to Canada's then Minister of Health Mme. Monique Begin. Ile said she was also given 30,000 letters from the public requesting the legalization of heroin. Soon after reviewing these materials, Mme. Begin formed the Medical Advisory Committee on the Management of Severe Pain. Walker criticizes the minister's judgment since the committee included several "au-thorities who had already denied the need for heroin.

"It was obvious the fox had been put in charge of the hens," Walker comments, "and the government was not about to admit it had been wrong for 29 years. Even a massive public response was not going to change the law....I concluded that money was re-quired to continue the fight."

In 1983, Walker founded the W. Gifford-Jones Foundation and asked his readers to send contributions. "I tried to convince the public it made more sense to spend money trying to legalize heroin than to waste it on flow-ers for the deceased."

Legal heroin won the battle, but lost the war

On Dec. 4, 1984, the Minister of Health announced the legalization of heroin. "But its use would be restricted by protocol," Walker says. "We won a huge battle against the formidable op-ponents. But it appears we had lost the war.

"It [government protocol] means we are using miniscule amounts of heroin in Canada. In fact, during 1988, Ontario was the only province to re-quest heroin. This was predictable. And critics now say, 'We told you no one wanted heroin. Why didn't you listen to us and not Gifford-Jones?' But the fail-ure to prescribe heroin is not due to an inherent fault ofheroin. Rather it is the red tape required to requisition heroin that can cause its disuse. It is human nature that doctors will follow the path of least resistance. Busy physicians have little time or inclination to fill out forms or seek permission from a com-mittee to prescribe heroin. So heroin is going to remain buried in dust while Canadians continue to die in agony.

- "The [Canadian] government claims that security is the main reason for placing heroin in a special drug category," Dr. Walker explains. In 1986, he traveled to Edinburgh, Scotland, where the Police Drug Squad told him that not even a single break-in for heroin had been recorded that year. "I visited small towns, talked to rural physicians and pharmacists and was told that they treated heroin like any other narcotic. Heroin was stored in the doctor's office, medical bag, and in the village phar-macy." Walker discussed the drug's security status with Scotland Yard officials and was surprised to find that it was not on their list of priorities.

The W. Gifford-Jones Foundation is currently using available funds to focus public attention on how poorly pain is treated in Canada, among other projects aimed at making the "legal-ized" heroin more practically available to physicians. Donation funds are also used to purchase subcutaneous infu-sion pumps for hospital and home use.

So how could the U.S. medicalize heroin and use the Canadian experi-ence to prevent making the same mis-takes?

"Go for the jugular in a campaign to medicalize heroin," Dr. Walker ad-vises. "Never, never allow politicians to surround heroin use with red tape. If you accept this proviso you lose the game."

BK

References
W. Gifford-Jones Foundation, 64 Harbour Square, Suite 1110, Toronto, Ontario M5J2L4, Canada. (416) 364-2311. Kenneth Walker, M.D., President and Founder.
Ministry of Health and Welfare, Brooke Claxton Building, Ottawa, KlA OK9, Can-ada. (613) 957-2991. Perrin Beatty, Minis-ter.
Canadian Medical Association, P.O. Box 8650, Ottawa, Ontario, K1G 0G8, Canada. (613) 957-2991. Dr. John O'Brien-Bell, President.