vancouver thread

[JTemperance]

Interesting. Still not sure if it's oral or parenteral hydromorphone in this context.

The hydromorphone-in-Vancouver thing I was familiar with was not this vending machine, it was a quite large study (hundreds of users) over a year or so where they had one group using pure heroin/diamorphine and the other using hydromorphone, to basically see if HM was a reasonable substitute for heroin in maintenance. (Conclusion: It is. Surprisingly, hardly any of the subjects could accurately tell which they were on, when they were asked as part of the study. However, the ratio of milligrams used between hydromorphone and heroin only ended up being about 1:2, which surprised researchers since they thought hydromorphone was more potent than that based on common equivalence charts for pain.)

In this one, the drugs were available to be injected, three times a day I think, exclusively on-site. Nurses supervised the injections and the dose escalation, and you were only allowed to try IV'ing in your arms; otherwise you could IM it in your thighs. This study also involved long-term methadone failures, and I think they took urine screens but didn't withhold dosing unless you were visibly intoxicated, and only threw people out for aggressive behavior or prolonged absence.

 

[sekio]

Dr Mark Ujjainwalla, an addictions doctor who runs Recovery Ottawa in eastern Canada, says users of illegal drugs need treatment for their conditions rather than easier access to substances. He argues such schemes are in effect ushering users towards death, rather than treating curable conditions.

“If you were a patient addicted to fentanyl [and you came to me], I would say: ‘OK, I will put you in a treatment centre for one to three months, get you off the fentanyl, get you stable, get your life back together and then you’ll be fine.’ Why would I want to give you free heroin and tell you to go to a trailer and inject?"

That's funny, the opposite is actually happening from what I understand... several addiction management/detox places here won't take fentanyl/opioid addicts who aren't also dependent on benzos or alcohol, because with the potency of dope here, you have people who undergo detox/psych ward stays or what-have-you, and then when they get out and relapse (as many do), they cop their usual fix of fentanyl, OD bigtime, and either have to be filled with naloxone (if they're lucky) or end up dead. So admitting people to rehab ends up doing more way more harm than maintenance therapy.

I think a second factor is that benzo/alcohol/GABAergic withdrawal is much more risky in terms of seizures, delerium and the like. Fentanyl withdrawal is incredibly unpleasant but it generally is much less risky in terms of safety (not that people don't end up with medically hazardous complications sometimes).

Interesting. Still not sure if it's oral or parenteral hydromorphone in this context.

The pills dispensed are the Dilaudid-type ones that are basically all lactose and drug, and are injected by the end user in the comfort of their home.

 

[S.J.B.]

The hydromorphone-in-Vancouver thing I was familiar with was not this vending machine, it was a quite large study (hundreds of users) over a year or so where they had one group using pure heroin/diamorphine and the other using hydromorphone, to basically see if HM was a reasonable substitute for heroin in maintenance. (Conclusion: It is. Surprisingly, hardly any of the subjects could accurately tell which they were on, when they were asked as part of the study. However, the ratio of milligrams used between hydromorphone and heroin only ended up being about 1:2, which surprised researchers since they thought hydromorphone was more potent than that based on common equivalence charts for pain.)

In this one, the drugs were available to be injected, three times a day I think, exclusively on-site. Nurses supervised the injections and the dose escalation, and you were only allowed to try IV'ing in your arms; otherwise you could IM it in your thighs. This study also involved long-term methadone failures, and I think they took urine screens but didn't withhold dosing unless you were visibly intoxicated, and only threw people out for aggressive behavior or prolonged absence.

What you're talking about is the SALOME study.