TORONTO - The treatment Gordon Stuckless hopes will help him secure a lighter sentence is effective in managing sexual impulses, say experts, but the courts can't force the convicted pedophile to undergo so-called chemical castration.
Stuckless, who is set to be sentenced Thursday for sexually abusing 18 boys over several decades, has voluntarily received injections of sex drive reducing medication for years in what his lawyer has described as a successful effort to keep from reoffending.
Ari Goldkind has argued that while his client will always be a pedophile, the shots are the best way to prevent him from acting on those urges, and his willingness to submit to such extreme measures should be a mitigating factor at sentencing.
Prosecutors, meanwhile, have expressed concerns that Stuckless has not gone through any kind of therapy or counselling to supplement the treatment, and legally cannot be compelled to keep up the injections.
Chemical or pharmacological castration, which reduces testosterone levels but does not change sexual orientation, has stirred debate since it first came into use roughly half a century ago.
Critics have sounded the alarm over the risk of coercion — from the justice system, family members or even employers — to submit to a treatment that, while reversible, can have intense side effects.
The treatment largely replaced surgical castration, which was still in practice in the U.S. and certain European countries until the early 1970s and has since been legally reintroduced in some American states, according to a report by the World Federation of Societies of Biological Psychiatry.
Likewise, the state of California passed a law 20 years ago mandating chemical castration for repeat child molesters, a move several other states have also considered, the report said.
In Canada, the courts can't order offenders to undergo chemical castration — they can only impose psychiatric treatment, which can include the use of anti-libido medication, experts said.
Chemical castration can, however, be made a condition for parole but it cannot be imposed once the sentence has been completed.
Neither the Correctional Service of Canada nor the Parole Board of Canada maintain statistics on how many offenders are undergoing chemical castration and experts say it can be difficult to track.
"We don't have a good estimate of how often sex drive reducing medications are used," said Michael Seto, director of Forensic Rehabilitation Research at the Royal Ottawa mental health centre.
"One problem is that there can be serious side effects so some pedophilic offenders are unwilling to try them, or try them and then quit or have to quit because of the side effects."
The vast majority of people who undergo chemical castration are men, though a similar treatment can be used on women, said John Bradford, a forensic psychiatrist at the University of Ottawa. Women are far less likely to commit the type of violent sexual offence that would require such intervention, he said.
Though it is generally used in cases where someone has committed a crime, some struggling to curb their deviant desires also occasionally resort to pharmacological castration, said Bradford, who has written extensively on pedophilia and sexual offenders.
Some who perform auto-erotic asphyxiation — a form of bondage that includes airway restriction — seek out the treatment because they feel they are in "real danger of hanging themselves" with elaborate harnesses, he said.
"When people come to me knowing the risk is sudden death, we have discussed pharmacological — and in one case, physical — castration," he said.
The World Federation of Societies of Biological Psychiatry report, which was issued in 2010, found few published controlled studies on the use of anti-libido drugs, and pointed to ethical barriers in conducting randomized research on such intrusive treatment.
But it found open studies showed some success, particularly with gonadotropin-releasing hormone analogues such a leuprorelin, better known as Lupron, a commonly used form. Lupron's primary purpose is to treat advanced prostate cancer by reducing testosterone.
That category of drug "progressively led to and maintained the inhibition of the fundamental elements of male sexuality: sexual fantasies, desire, and interest in sexual activities, resulting in either a dramatic decrease or an abolishment of the sexually deviant behaviour," the report found.
Some patients, however, were still able to masturbate and have sex, it found.
Lupron and other such drugs function by stimulating the pituitary gland to release a hormone that triggers testosterone production, causing it to surge. With continuous stimulation, receptors in the pituitary eventually become desensitized and testosterone levels drop to castration levels.
That initial surge in testosterone can increase the risk of offending and must be mitigated with other anti-libido drugs, Bradford said. The same phenomenon occurs when treatment is abruptly cut off, hence the need for gradual weaning, he said.
Possible side-effects of the drug include feminization — the development of female sexual traits — as well as depression and bone density loss, also called osteopenia.
The effects on bone density are the "biggest concern," given that most patients have to pursue the treatment over long periods, Bradford said.
Any such treatment must be accompanied by regular psychiatric care to ensure effectiveness and health, and access to such care is inconsistent across Canada, he said.
There are several facilities that offer the treatment in Ontario, including sexual behaviours clinics at the Royal Ottawa centre and Toronto's Centre for Addiction and Mental Health, and the Brockville Mental Health Centre — a medium-security correctional facility for adult male offenders diagnosed with a mental illness, including violent sexual offenders.
Services in other provinces are "less comprehensive," Bradford said.
And while chemical castration alone can help control sexual impulses, it should be accompanied by other forms of therapy, said Bradford, noting that the more people understand their condition, the better they can manage it.
Even some who have committed horrific sexual crimes can often safely reintegrate in their communities, said Bradford.
"You can never reduce the risk to zero per cent," he said. "Part of the struggle is, what level of risk is acceptable in a community?"