Another Successful Heroin Trial - Canada

Finally, the results are in from the North American Opiate Medication Initiative (NAOMI) enquiry into prescription heroin. Ironically though, it’s a bit of a fizzer. It just told us what has already been proven over and over again ... that prescription heroin is a vastly superior treatment than all other current or proposed programs for heroin addiction.

Canada is just the latest country to produce evidence that prescription heroin is more effective than methadone or abstinence based programs. Switzerland, Germany, The Netherlands and Spain have all had heroin trials and documented their success. The UK is currently finishing off their own trial which is already indicating similar results. Belgium, Israel, Denmark and other countries have announced they will also be conducting their own trials or have indicated their interest in doing so.

All participants reduced their involvement in crime and their spending on drugs, and all participants had health improvements, but those in the injectable heroin or hydromorphone group saw the greatest improvements overall. 
-Jessica Werb. Health Straight Talk

Many countries will now be in that political quagmire that faced Australia back in the late 1990s. Is it worth risking political points and the inevitable attacks from the anti-everything brigade for implementing the safest and most successful treatment program to tackle heroin addiction? Luckily this time around, Australia won’t have John Howard to override the consensus of the states or fellow politicians but the Rudd government is yet to prove itself in providing an evidence based policy. There has been no clear direction yet from the government except the usual political posturing about being tough on drugs. Rudd did claim that he would support evidence based policies but drug policy doesn’t always follow the usual rules. Is this going to be too much of a stretch for a church going conservative? Are the likes of Drug Free Australia (DFA) and the twats from the MSM going to derail another attempt at treating a medical problem based on science and research?

Results show that North America’s first heroin therapy study keeps patients in treatment, improves their health and reduces illegal activity
North American Opiate Medication Initiative (NAOMI Study)


VANCOUVER, BC, October 17, 2008 – Researchers from the North American Opiate Medication Initiative (NAOMI Study) today released final data on the primary outcomes from the three-year randomized controlled clinical trial.

“Our data show remarkable retention rates and significant improvements in illicit heroin use, illegal activity and health for participants receiving injection assisted therapy, as well as those assigned to optimized methadone maintenance,” says Dr. Martin Schechter, NAOMI’s Principal Investigator, Centre for Health Evaluation and Outcome Sciences and Professor and Director, University of British Columbia School of Population and Public Health. “Prior to NAOMI, all of the study participants had not benefited from repeated standard addiction treatments. Society had basically written them off as impossible to treat.”

The data, which was collected from 251 participants at sites in Vancouver and Montreal, demonstrate that a combination of optimized methadone maintenance therapy (MMT) and heroin assisted treatment (HAT) can attract and retain the most difficult-to-reach and the hardest-to-treat individuals who have not been well served by the existing treatment system.

Key findings at the 12-month point of the treatment-phase of the study showed that HAT and MMT achieved high retention rates: 88 per cent and 54 per cent respectively. Illicit heroin use fell by almost 70 per cent. The proportion of participants involved in illegal activity fell by almost half from just over 70 per cent to approximately 36 per cent. Similarly, the number of days of illegal activity and the amount spent on drugs both decreased by almost half. In fact, participants once spending on average $1,500 per month on drugs reported spending between $300-$500 per month by the end of the treatment phase. Marked improvements were also seen in participants’ medical status with scores improving by 27 per cent.

Of particular note amongst the findings, participants receiving hydromorphone (DilaudidTM) instead of heroin on a double-blind basis (neither they nor the researchers knew) did not distinguish this drug from heroin. Moreover, hydromorphone – an opiate licensed for the relief of pain - appeared to be equally effective as heroin, although the study was not designed to test this conclusively. According to the NAOMI Study Investigators, further research could help to confirm these observations, allowing hydromorphone assisted therapy to be made more widely available.

While a comprehensive health economics study is pending, researchers have already determined that the cost of continued treatment is much less than that of relapse.

“We now have evidence to show that heroin-assisted therapy is a safe and effective treatment for people with chronic heroin addiction who have not benefited from previous treatments. A combination of optimal therapies – as delivered in the NAOMI clinics - can attract those most severely addicted to heroin, keep them in treatment and more importantly, help to improve their social and medical conditions,” explains Schechter.

A summary report of the findings and background information on the study are available at: www.naomistudy.ca

 

NAOMI trial finds heroin more effective than methadone
By Jessica Werb
Health Straight Talk

Heroin-assisted therapy is a safe and highly effective treatment for people with chronic heroin addiction, according to the final data released by the North American Opiate Medication Initiative (NAOMI) today.

The three-year randomized controlled clinical trial, lead by Dr. Martin Schechter of UBC’s School of Population and Public Health, included 251 participants at sites in Vancouver and Montreal. Forty-five percent were given oral methadone, 45 percent were given injectable heroin, and 10 percent were given injectable hydromorphone, an opiate licensed for pain relief.

Those treated with heroin had a retention rate of 88 percent, compared to 54 percent for participants who received optimized methadone maintenance therapy.

Sixty-seven percent of those treated with heroin responded to treatment, compared to 47.7 percent of those treated with methadone.

Illicit heroin use declined in all patients, but was declined most sharply among those treated with injectable heroin or hydromorphone.

All participants reduced their involvement in crime and their spending on drugs, and all participants had health improvements, but those in the injectable heroin or hydromorphone group saw the greatest improvements overall.

The study also found that participants receiving hydromorphone did not distinguish it from heroin, and that it appeared as effective in treatment as heroin. However, researchers noted that the study was not designed to test this conclusively.

Given their less-than-enthusiastic reaction to InSite, I wonder how Stephen Harper and the RCMP are going to react to these findings?

Prescribed Heroin Project 'Promising'

For many hardcore heroin addicts, the hustling begins first thing in the morning. They wake up with one thing in mind: How to get their next fix. Some turn to panhandling, prostitution or crime to come up with the cash for drugs. But a heroin study seems to have changed that for some Montreal addicts.

Prescribed Heroin Project 'Promising' Brett Bundale The Gazette June 2008

North America's first research study on medically prescribed heroin will wrap up in a few weeks. The goal of the North American Opiate Medication Initiative, funded by the Canadian Institute of Health Research, is to examine harm reduction and the treatment of illicit drug use.

The $8-million clinical trial started in 2005 in Montreal and Vancouver, the site of Insite, North America's only safe-injection site.

As the project winds down, Quebec is considering setting up a safe-injection facility in Montreal, Health Minister Philippe Couillard said Wednesday.

But unlike a safe-injection site, where addicts inject themselves with their own street drugs under the supervision of a nurse, the research study uses medically prescribed pharmaceutical-grade narcotics.

Although the findings will not be published until the fall, the preliminary results are promising, said Suzanne Brissette, one of the study's doctors and the lead investigator in Montreal.

"The cost effectiveness will be an important part of our findings," Brissette said.

In addition to the human costs, an untreated heroin addict costs Canada an estimated $45,000 a year in public health care, criminal justice and welfare.

Similar studies in Europe suggest prescribed heroin programs can save the public nearly $20,000 a year per addict, after research and clinical costs are factored in.

The North American study offered addicts information about how to avoid some of the risks of drug use, like using shared or unsterilized needles, and how to manage - if not kick - the habit.

Heroin users are at risk of developing abscesses, contracting such diseases as HIV/AIDS and hepatitis C, and other problems related to adulterated heroin sold on the street.

In Montreal, addicts were allowed to come to the clinic three times a day to get their fix.

"What was surprising was that, as their lives gained stability, many came only twice a day," Brissette said.

In addition, the maximum heroin dose allowed was about 400 milligrams, but on average addicts chose to take only 170 milligrams at a time.

"Because the heroin was free, people thought an escalation in use would occur. But this didn't happen," Brissette said.

The study followed a strict recruitment process.

"There was a fear we'd attract more users by giving out free heroin," Brissette said.

"The participants had to have repeatedly failed the standard treatment," Brissette said, which involves oral methadone, a drug similar to morphine, as a substitute for heroin.

Once selected, nearly half the participants underwent the standard methadone treatment. The other 55 per cent received either heroin or another opiate that is injected, hydromorphone.

Many users put on weight and some managed to find jobs, Brissette said.

Hydromorphone Trial

What ever happened to the proposed Hydromorphone trials in the ACT?. The proposal for a Hydromorphone trial in the ACT in 2003 was led by the ACT health minister, Simon Corbell and strongly supported by ACT opposition leader, Brendan Smyth. The ACT government took the proposal to the Ministerial Council on Drug Strategy in Adelaide in November, 2003. The state and territory ministers endorsed the right of the ACT to hold the trial, but none were willing to join the program.

Why did the heroin trial only a few years before have so much support yet this trial got the royal cold shoulder. Nearly all the states and territories were labour and they all seemed to toe the line from the Federal Liberal Party who pushed hard with their 'Tough on Drugs' policy. I would guess Howard quietly warned the states and territories that supporting this trial would effect their funding. This is the style of the US who threatened Howard when the heroin trials were first raised in 1997 and it makes sense that Howard has has learnt well from his master.

ACT opposition leader, Brendan Smyth had some wise words for us:

I think it's unfortunate we don't look at options for keeping people alive - that's the fundamental driver on this for me, If this is an option that stops someone from overdosing on extra-strength heroin or getting blood-borne contamination from using a dirty needle, then I'd like to try it simply because we all should aiming at the preservation of life

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