Pubdate: Sat, 18 Oct 2008
Source: Vancouver Sun (CN BC)
Copyright: 2008 The Vancouver Sun
Contact: http://www.canada.com/vancouversun/letters.html
Website: http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Chad Skelton
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?131 (Heroin Maintenance)
Bookmark: http://www.mapinc.org/find?136 (Methadone)

PAINKILLER WORKS FOR HEROIN ADDICTION

Dilaudid as effective as heroin, and more effective than methadone,
for addicts, study shows.

A commonly prescribed drug used in cough medicine is more effective
than methadone -- and as effective as heroin itself -- at stabilizing
the lives of heroin addicts and reducing their use of street drugs,
according to a new study from Vancouver.

Since March 2007, the North American Opiate Medication Initiative has
been prescribing 115 addicts in both Vancouver and Montreal with
medical-grade heroin to see if they would fare any better than a
control group of 111 on methadone.

The results, released Friday, concluded addicts on heroin stuck with
treatment longer and had more success than the methadone group -- no
surprise, since similar studies in Europe found the same thing.

What was surprising, however, is that a smaller group of 25 addicts
given Dilaudid -- a legal drug used as a painkiller and cough
suppressant -- fared just as well as those on heroin.

It was such a convincing substitute that all but one of those on
Dilaudid told researchers they thought they were on heroin.

The implications of the finding are potentially huge.

That's because while giving addicts free heroin would require approval
from Ottawa -- a hard sell for a Conservative government already
opposed to supervised injection sites -- prescribing addicts Dilaudid
is simply an off-label use of a legal drug.

"To be perfectly frank, there is a stigma attached to heroin," said
Dr. Martin Schechter, principal investigator for the NAOMI project.
"That would make [Dilaudid] particularly attractive in places where
the concept of using heroin would be untenable as a public policy."

Schechter said B.C. doctors would have to get approval from the
College of Physicians and Surgeons to use Dilaudid to treat addiction.
And health authorities would have to pay for clinics to dispense it.
But in comparison to prescription heroin, he said, the regulatory
hurdles are tiny.

Because the number of addicts in the study taking Dilaudid was so
small, Schechter said, he'd like to see more research done to confirm
it really works.

And heroin should still be an option for those who don't respond to
Dilaudid, he said.

But researchers are already in talks with the Vancouver Coastal Health
Authority about converting NAOMI's research site on Abbott Street into
a permanent drug-treatment clinic offering both methadone and Dilaudid.

Schechter said the clinic could treat about 200 addicts at an annual
cost of about $1.5 million.

And while that's not cheap, Schechter said the $7,500 per addict is a
bargain compared to the estimated $50,000 an untreated addict costs
the health-care and criminal-justice systems.

The NAOMI study found significant improvements in the lives of those
on methadone, heroin and Dilaudid. Those in treatment spent less money
on street drugs, committed fewer crimes to feed their habit and saw
improvements in both their physical and mental health.

For example, on average, methadone users reduced their spending on
street drugs from $1,500 to $500 a month. Those on heroin or Dilaudid
spent only $350 a month on street drugs.

NAOMI purchased medical-grade heroin from Europe for about $10 per 500
mg, Schechter said, compared to hundreds of dollars for a similar
amount on the street. Dilaudid was about the same price.

Vancouver Mayor Sam Sullivan said the B.C. government should
immediately begin offering Dilaudid therapy to Vancouver addicts and
press Ottawa to allow heroin therapy as well.

B.C. provincial health officer Dr. Perry Kendall said he'd also like
to see NAOMI stay open to offer methadone and Dilaudid.

Vancouver Coastal Health spokeswoman Anna Marie D'Angelo said the
health authority is reviewing NAOMI's research but said it's too early
to say if it would provide funding to keep the clinic open
permanently.

B.C. Health Minister George Abbott released a statement saying the
government is "committed to both evidence-based abstinence and harm
reduction approaches" and will decide whether to fund new programs
after reviewing the research.

Federal Health Minister Tony Clement did not respond to an interview
request Friday.

While governments decide whether or not to treat addicts with
Dilaudid, some are taking matters into their own hands.

Rob Vincent, 36, had been using heroin for 15 years when he was
enrolled in NAOMI in 2005 and placed in the heroin group.

Vincent said he stopped buying street drugs entirely during his
treatment, saving himself $50 to $100 a day.

And when his participation ended in March 2007, he decided to give
Dilaudid a try, since -- at $10 for an 8 milligram pill on the street
- -- it's a lot cheaper than heroin.

"They were using that in the NAOMI study, so I gave it a try," Vincent
said. "It lasts a lot longer

. . . and it's just as good as heroin."

HELPING ADDICTS STICK WITH TREATMENT

The North American Opiate Medication Initiative treated 251 addicts
with methadone, heroin or a legal painkiller known as Dilaudid. The
study found that addicts treated with heroin were much more likely to
stick with treatment, and had better health, than those on methadone.
But, most surprisingly, it also found that the Dilaudid group did just
as well as those on heroin.
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MAP posted-by: Larry Seguin