Even if groundbreaking research into a substitute treatment for heroin is successful, heroin itself should be available as a medical option for addicts, a top addictions researcher told The Globe and Mail Tuesday.
“Like in any other medical condition, patients respond well to a given treatment, but not all of them,” Eugenia Oviedo-Joekes said in a forum on The Globe's website.
Dr. Oviedo-Joekes is a principal investigator of the SALOME project, which is recruiting heroin addicts for a medical trial that will offer both heroin and a legal narcotic substitute to determine their effectiveness as a harm-reduction treatment. While the long-term goal is to help the addicts get off hard drugs, in the short term, the plan is to get them away from the more dangerous aspects of heroin addiction, such as committing crimes, sharing needles, and shooting up in back alleys.
The Study to Assess Longer-term Opioid Medication Effectiveness, set to open clinics in Montreal and Vancouver by the end of this year, is building on a previous medical trial that found addicts were healthier and committed fewer crimes when given heroin in a clinic.
Dr. Oviedo-Joekes said there is already ample evidence that heroin is an effective medical treatment for addicts who have not responded to traditional methadone treatment: “Methadone works very well, [but] not for everyone. We need alternatives to avoid leaving behind anyone that needs care.”
Later, she said the SALOME trial will be the first to measure in depth whether Hydromorphone, a legal narcotic available by prescription in Canada under the name Dilaudid, can work as a substitute treatment.
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A clinic station where a patient can administer their dose of heroin is seen in Montreal on Monday June 6, 2005.
“Heroin-assisted treatment works; I cannot go against the evidence. If Hydromorphone works as good as heroin, we can provide an alternative until our society is ready to accept other approaches, such as heroin.
“There is no treatment that will be effective for everyone, and we need to have alternatives ready.”
In the SALOME trial, roughly 200 addicts will be offered either heroin or Hydromorphone in double-blind tests. In a second stage, researchers will offer subjects the same drugs in pill form to test a safer alternative to injection treatment.
Dr. Oviedo-Joekes noted that between 15 and 25 per cent of people who have tried methadone to break their habit have ended up back on the street using illicit drugs. That's the group from which the trial will recruit addicts: “We are looking for people who have tried [methadone] and are still using opiates daily in the street.”
She noted that heroin treatment is still a tough sell in Canada, although it is being tried in several European countries. But she said it is a necessary step toward a more effective approach to drug addiction problems that are so visible in Vancouver's Downtown Eastside.
“It's not one trial that is going to save the Downtown Eastside. It's a vision of treating these most vulnerable people who deserve our care and our time and our money.”
Dr. Perry Kendall, the provincial health officer, said he supports the medical trial.
“It's really valid research and it opens up options for different treatment,” he said in an interview. “If you could substitute Hydromorphone, that doesn't have the stigma or the regulatory hoops you have to go through if you are importing heroin. It becomes a lot more feasible and a lot cheaper.”
But he said a political commitment is needed to follow through in any meaningful way.
“It will be nothing if we don't have the facilities to deliver it as a specialized treatment,” he said. “At the moment we are facing some tough choices in a very tight budget year, and that's where some of the issues of stigma come in because you're competing with highly expensive cancer treatments and hip replacements for people who have worked all their lives.”
) The Swiss also did trials with heroin maintenance, I believe they were the first ones. Also, diamorphine used to be commonly prescribed to addicts in UK, still is to a much lesser degree... And if I remember correctly, it was also prescribed to addicts in the US, I wanna say in the '20's and '30's though.
