Should terminally ill patients be denied effective relief because heroin carries a stigma?

Every so often, history taps you on the shoulder. That happened to me recently when I discovered a book on the science, culture, and regulation of drugs by Professor Lucas Richert, a historian of pharmacy at the University of Wisconsin-Madison. The book devotes its entire first chapter to none other than my father, Dr. Ken Walker; better known to readers by his penname, W. Gifford-Jones, MD.

Richert’s book, Strange Trips, presents the history of recreational, palliative and pharmaceutical drugs and the tension in debates between evidence and opinion, compassion and politics.

Readers may not know that in the late 1970s and early 1980s, my father became Canada’s most vocal advocate for the legalization of medical heroin. He had lost close friends to cancer and seen his own patients suffering in pain. At the time, heroin was widely used in Britain for pain control, yet Canadian patients were denied access. Why? Not because of science, he argued, but because of “political, not medical, decisions.”

Richert captures this clash well. As one expert observed, “Heroin is particularly good at inducing opinions which conflict with all the evidence and ‘evidence’ that is then moulded to fit the opinions.” My father’s campaign forced Canadians to ask: should terminally ill patients be denied effective relief because heroin carried a stigma?

He didn’t stop advocating for change in his column. He collected more than 30,000 signatures on a petition, received another 20,000 letters of support, and presented them in Ottawa to Health Minister Monique Bégin. He flew to the UK on a fact-finding mission, speaking with doctors, nurses, and patients. Scotland Yard officials, he noted, brushed off the claims of critics that medical heroin stored in hospital pharmacies would increase crime. They had far bigger problems to worry about.

When political action stalled, he doubled down, placing full-page awareness ads in newspapers. In one, he accused opponents with the blunt headline: “Will the real hypocrites please stand up.” That kind of language didn’t make him friends in the medical establishment or in policy circles, but it drew public attention to the cause.

Support began to build. Editorials in The Toronto Star and The Globe and Mail endorsed his position, pointing out that British cancer patients had long had access to heroin without social upheaval. The Canadian Medical Association ultimately supported legalization, after uncovering how Canada had been pressured decades earlier by the United States into banning the drug. Dr. William Ghent, a leading CMA figure, didn’t mince words, “We followed the US like sheep, and now, like sheep, we’ve got their manure to deal with.”

By the mid-1980s, the government relented. New trials were approved, and eventually heroin was legalized for cases of severe chronic pain and terminal illness. The fight didn’t end debates in palliative care, and experts then and now would argue the focus should be broader than drugs alone. It was a turning point. Canada acknowledged that compassion had a place in drug policy.

The debate continues today in a new form. Researchers now point to psychedelics such as psilocybin as tools to ease end-of-life distress, yet patients face the same barriers of politics, stigma, and delay. Humans often fail to learn from history, and as Richert’s book shows, the fight over heroin was just one of many stories.

For me, it is a point of pride to see my father’s efforts remembered, not only as a medical crusade, but as part of the larger story of how societies negotiate the meaning of medicine. Readers who want more detail can find a synopsis of Richert’s chapter, published in the Canadian Medical Association Journal, available through our website.

This column offers health and wellness, not medical advice.