Pubdate: Thu, 07 Apr 2016
Source: Globe and Mail (Canada)
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Andrea Woo
Page: S1
Referenced: Hydromorphone Compared With Diacetylmorphine for 
Long-term Opioid Dependence: 
http://archpsyc.jamanetwork.com/article.aspx?articleid=2512237
Bookmark: http://mapinc.org/topic/NAOMI
Bookmark: http://mapinc.org/topic/SALOME

DRUG TRIAL SPURS HOPE FOR HEROIN TREATMENT'S VIABILITY

People with chronic heroin addiction may soon have another treatment 
option after the conclusion of a groundbreaking study in Vancouver's 
Downtown Eastside.

The four-year Study to Assess Longer-term Opioid Medication 
Effectiveness (SALOME), led by principal investigator Dr. Eugenia 
Oviedo-Joekes, examined whether hydromorphone, a licensed pain 
medication, is as effective in treating a chronic heroin addiction as 
diacetylmorphine, also known as pharmaceutical-grade heroin.

The results, which will appear in Wednesday's edition of the Journal 
of the American Medical Association Psychiatry, show it is.

Participants on both medications reported three to five days a month 
of illicit drug use, compared with almost daily illicit drug use 
prior to the study. As well, illegal activities dropped to an average 
of less than four a month, compared with an average of more than 14 a 
month before the study.

Participants in the double-blind study could not determine which drug 
they were receiving, researchers found.

Max, whose last name was not released, told a news conference 
Wednesday his life spiralled out of control for nine years as a 
result of a heroin addiction after a car crash.

He said he was living on the streets, barely eating and constantly 
hungering for his next fix.

Methadone treatment failed, and he thought he was going to die. But 
in 2011, he was recruited into the SALOME study. Max didn't know 
which of the two medications he was getting as part of the four-year 
study, but he knew one thing: He wasn't craving illicit heroin, and 
he wanted to live.

"I turned 50 yesterday," said Max, one of 202 participants in the 
SALOME trial. "I'm not sure I'd even be here today if I didn't take 
this study."

It's the first time hydromorphone, commonly used in palliative and 
acute care, has been evaluated as a substitution treatment for opioid 
dependence.

"Chronic addiction has huge consequences for individuals and 
society," said Dr. Scott MacDonald, who oversaw trials at Providence 
Health Care's Crosstown Clinic from late 2011 to late 2015. "We now 
have an additional treatment option - one that does not have the 
political and regulatory obstacles and stigma that prescription 
heroin has to it."

Hydromorphone is also readily available in Canada, whereas 
prescription heroin is manufactured by a pharmaceutical company in 
Europe and must be imported through an onerous process.

This new option builds on heroin-assisted treatment, a secondary 
treatment targeted at entrenched addicts who have failed repeatedly 
with traditional options such as methadone or buprenorphine. For 
them, receiving prescription-grade heroin in a supervised, medical 
setting has been shown to improve physical and mental-health outcomes 
and reduce illicit drug use and related criminal activity.

SALOME's participants averaged more than 15 years injecting street 
heroin and had attempted methadone several times in the five years 
prior to beginning the study.

Dr. Oviedo-Joekes, SALOME's lead researcher, noted that 80 per cent 
of participants stuck with the study - an important finding, because 
injection drug users are at high risk for HIV and other blood-borne 
illnesses and may not frequently engage with the health-care system. 
During the study, participants saw doctors three times a day.

"We see them every day. We have an opportunity to provide 
comprehensive care," she said. "This is a very small group of 
patients - not more than 10 per cent of everybody on substitution 
treatment - but they are the ones that are the most vulnerable. They 
are the ones we have failed over and over with every other treatment."

In an e-mailed statement, the the College of Physicians and Surgeons 
of B. C. said its Prescription Review Program staff "will be 
interested in reading the full study to understand the implications 
going forward."

SALOME is the next chapter of the North American Opiate Medication 
Initiative ( NAOMI), North America's first clinical trial of 
prescription heroin, which took place from 2005 to 2008. That study 
confirmed the effectiveness of heroin- assisted treatment - currently 
offered in Switzerland, Denmark, Germany, the Netherlands and Britain 
- - but produced the unexpected finding that a small group of 
participants who had received hydromorphone seemed to yield the same benefits.

SALOME was then launched to investigate whether hydromorphone is as 
effective as prescription heroin in heroin- assisted treatment.

- - With a report from The Canadian Press
- ---
MAP posted-by: Jay Bergstrom