Showing newest posts with label Heroin Trials. Show older posts
Showing newest posts with label Heroin Trials. Show older posts

Tuesday, 1 June 2010

UK Push for Expanding Heroin Assisted Treatment

A recent article in the medical journal, The Lancet has once again highlighted the need for Heroin Assisted Treatment (HAT) to be expanded in the UK.

Although the article draws upon previously released research results, it was still important enough to catch the media’s attention.

A Google News search found 182 related articles including from The Press Association, The Associated Press, TopNews, Pharmacy News, Reuters, BusinessWeek, BBC News, CBC, The Northern Echo, Irish Independent etc. but not a single mention from any major media outlet in Australia.

The only Australian article I found was in the hard copy edition of the Townsville Bulletin.


Heroin Therapy Call for 'Chronic Addicts'
By Emma Wilkinson - Health Reporter
May 2010

Injectable "medical" grade heroin should be offered under supervision to the most hardened addicts, say UK researchers.

A trial in 127 addicts who had persistently failed to quit the drug showed a significant drop in use of "street" heroin after six months.

Writing in The Lancet, the researchers said the "robust evidence" supports wider provision of heroin treatment.

A spokesman for the government said it would consider the findings.

Around 5-10% of heroin addicts fail to quit despite use of conventional treatments, such as methadone.

Those who took part in the trial had been using the drug for an average of 17 years and had been in treatment for 10 years.

When they took part in the programme they were on methadone treatment but were still taking street heroin on a regular basis.

The researchers - working at clinics in south London, Brighton and Darlington - found that those offered injectable heroin under the supervision of a nurse were significantly more likely to cut down their use of street heroin than those receiving oral or injectable methadone.

Improvements were seen within six weeks of starting the programme, they reported.

In further analysis yet to be published, it was noted that the benefits remained after two years and some patients were able to stop use of the drug altogether.

Treatable
Study leader, Professor John Strang, from the National Addiction Centre at King's College London, said the supervised heroin programme enables patients to start thinking about employment, re-engaging with their families and taking responsibility for their lives.

"This is a treatment for a severe group of heroin addicts that ordinary treatments have failed with and the question we're answering is 'are these patients untreatable?'."

"The very good news is that you can get these people on a constructive trajectory."

He said the latest study plus a series of other trials now provide clear evidence that this type of treatment should be offered more widely.

It was outlined in the UK government's 2008 Drug Strategy, subject to the results from this trial.

He added that although more expensive than conventional treatments, heroin therapy is considerably cheaper than imprisonment.

A Department of Health spokesman said any approach that gets people off drugs for good should be explored.

"We will look at evidence and both the clinical and cost effectiveness of these treatments.

"However, it is vital that we do all we can to prevent people using drugs in the first place."

Dr Roy Robertson a reader in the Department of Community Health Sciences at Edinburgh University, said whilst none of the outcomes are close to achieving abstinence, treatment with supervised injectable heroin "seems to be our best option".

"This is the intensive care for those heroin users who have failed after all sorts of other available treatments and continue to inject."

DrugScope chief executive Martin Barnes added that there is no "magic bullet" and several treatment interventions may be needed before someone becomes drug free or cuts down their drug use.

"On the basis of the outcomes described, there is a strong case for extending heroin prescribing as a carefully targeted and closely supervised form of treatment for chronic addiction."


Related Articles

Sunday, 18 April 2010

Giving Free Drugs to Addicts

What is more important? Stopping; violent crime, theft, robberies, drug overdoses, thousands being murdered in drug wars, the spread of HIV and HCV etc. or trying to stop drug addicts getting high? History has revealed 2 things - you can’t have both and trying to stop society from using drugs simply does not work. So, which would you choose? ... stopping associated crime and violence or stopping users getting high?

I’m sure most rational people would prefer to cut out nasty social ills like robberies, HIV, HCV, violence and murder but I am just as sure that some muffins would be so anti-drug that they would refuse to answer or try to change the question. 

Most informed people already know that prohibition causes crime and violence whilst not having much success at lowering drug use but how about the public? Do they know this or do they simply find it difficult to acknowledge due to decades of misinformation from the authorities? Is legalisation or handing out free drugs to addicts just too radical for the everyday citizen even if it cut crime rates by half and changes society dramatically for the better? According to a recent survey by McNair Ingenuity Research, 66% of Australians think people would be more likely to try or use drugs if legalised but only 5% confess that they would indulge. 

One of the survey’s most interesting results concerned what people thought would happen if illegal drugs were decriminalized. Although only 3% of people said they would personally use drugs more often, 62% said they thought other people would. The results were similar when we asked whether you’d be more likely to try drugs at all (only 5% said they would, but 66% thought others would).

It seems we define the people who can’t be trusted with drugs as everyone but ourselves.

-Kirsten Drysdale - Hungry Beast. ABC TV

Giving drugs to drug addicts is not new. Most western countries supply highly addictive opioids like methadone, buprenorphine and suboxone to heroin addicts. Other countries give out Slow Release Oral Morphine (SROM) and even free heroin. These programs are heavily regulated and restricted to opiate abuse like heroin because opioids are basically non toxic. The most success has come from supplying heroin to long term addicts who have failed repeatedly in other treatment programs. The success or prescription heroin has prompted a growing trend for drug experts to push this strategy. 

The main problem is that many addicts don’t qualify for the program because of the strict guidelines and heroin is the only targeted drug (a limited number of cocaine addicts were also given their drug of choice in the latest UK scientific trial). What about those who missed out on the trials or those who are just not “hard core” enough to make it to a permanent program? What about users of cocaine, methamphetamines and prescription medications? Once again it seems that politics and ideology are robbing addicts of valuable treatment options. 

As an addict in Vancouver for 38 years I was certain I would have no problem attending the program. It seems they only took Downtown addicts which gave them a very limited demographic and my calls went from wait to forget it. You could contact the NAOMI people if you want info but you'll be searching through an unpublished project.I hope you discuss parameters as most trials make getting off of heroin a prerequisite, which kills the project as you may well imagine. Harm reduction and working and happy clients should be the goal.Don't let them set you up to fail. 
-Comment by Terry McKinney. Vancouver BC (28/05/2008) - The Australian Heroin Diaries

How imbecilic can we be when we know that most established addicts will use street drugs everyday but the idea of government supplying safe and free drugs is simply out of the question. Up will come that old argument that dishing out illicit drugs is dangerous to their health and we should be trying to get people off drugs, not encouraging them. These reasons might be fine in prohibition utopia where drugs can be eliminated but not in the harsh realms of reality. And that’s the problem. The people who make these important decisions aspire to a “Drug-Free World” which has more chance of being a Disneyland theme park than materialising on planet earth.

I was in Canberra when the trial was set to happen. Now a decade later, failed relationships, failed uni attempt, lost employment and still raging habit, i often wonder where i'd be now if it had've gone ahead. damn howard! i wrote to chief minister stanhope last year at 3am, hanging out, begging for him to think about another try. 6 wks later he replied (shock horror) and said he was 100% behind it, but couldnt do anything til howard was gone. well hes gone.......Methinks its time i start emailing again :) 
-Comment by plzHoldSteady (22/01/2008) - The Australian Heroin Diaries

I always wonder how many lives we could have saved and how many addicts would now be clean if the proposed ACT heroin trials weren’t poo-pooed by Howard. Given the success from every heroin trial overseas, it must be quite a few. Imagine how many lives we could save or change for the better if skipped the strict criteria for candidates of prescription heroin. What if we simply opened it up to anyone who has been on methadone for more than a year or had attended a rehabilitation program and failed? And what if we supplied all dangerous drugs like ice, cocaine, heroin etc. and even ecstasy and other drugs that can be contaminated with filler products? What is the real downfall of this idea compared to the benefits? The same groups would continue to use the same drugs and those who don’t use drugs would continue to abstain. The sky would not fall in and societal chaos would not engulf mankind. Some dedicated users might increase their intake but many more will take advantage of extra treatment options and quit using drugs. 

I don’t think the public has correctly been told what would happen to their surroundings if illicit drugs were distributed by the government or legalised. The most obvious effect is that crime would drop by about half and several billion dollars would be saved every year. This are not just a slight decrease in costs or small improvements but massive, unparalleled changes to crime rates and government spending. Whole police departments used to fighting drug crimes would be relocated to other, understaffed divisions ... including more cops on the street. The back log in courts would eliminated. Huge percentage drops in overdoses and deaths. Organised crime losing their most profitable source of illegal income. Prison populations dropping so much that not only won’t new jails be required in the near future but some actually might shut down. Dangerous meth labs would almost cease to exist. You would be able to buy flu tablets with pseudoephedrine again without having to produce your passport, a personal reference from an astronaut or leaving your first born as collateral. Convenience store workers, pharmacy staff and train travellers  won’t have to worry about desperate junkies robbing them anymore as they will cease to exist. The CourierMail, Adelaide Advertiser, Daily Telegraph etc. will have to expand their subject matter or lose 8-10 pages. The quality of drug education will improve ten fold. Young adults will no longer be so susceptible to a permanent criminal record. Teen drug use will drop as the mystique of drugs will be gone as well as unscrupulous drug dealers who don’t ask for age ID. The problem of alcohol will be addressed more rigourously and classed as a dangerous drug. And so on...

Ironically, easier access to drugs will improve life for users and addicts. Their health will greatly improve and many of them will be able to work once again. They will be able to re-establish relationships with their families and no longer run the risk of being imprisoned. Many of the health issues for drug addicts are the result of prohibition, especially for heroin users. Opiates including heroin are basically non toxic and can taken for decades with very few physical problems. Haven’t you ever wondered why street junkies on heroin look sick but those on pain medication look normal? They are both taking the same sort of drug but the most visible heroin addicts in society often don’t eat very healthily, sleep where ever they can, have very few clean clothes and are more focussed on dodging the police and paying for their next hit. Take away the high cost and the stigma attached to drug addiction and they get to live much more productive lives. In the countries where heroin is prescribed to addicts, there has been substantial improvements in their health and personal lives. Most of them cease any criminal activities and many find work. 

The big question is - why are other countries looking into evidence based strategies like heroin assisted treatment and related programs while Australia keeps regurgitating tired, old drug policies that fail every year?



New Approach To Drugs Seeks Footing In Costa Rica
April 2010

The drug debate in Latin America has started to shift.

For decades, possession and addiction in the Americas have been treated with a zero tolerance policy. Efforts to slow drug use have largely centered on arresting and punishing users.

But packed jails, overburdened court systems, and a growing consensus that the war on drugs is failing are transforming the discussion.

In August, 2009, Argentina's Supreme Court ruled that it was unconstitutional to prosecute people for possession of drugs for personal use. One month later, Colombia's high court issued a similar ruling.

In Peru and Bolivia, there are now small clinics that give cocoa leaves to crack addicts in order to manage and lessen their addiction. Bolivia's President, Evo Morales, has asked the United Nations to eliminate the narcotics label on the coca plant.

Now, in Costa Rica, high-ranking officials are joining the tolerance dialogue.

In March, Costa Rica's Chief Prosecutor, Francisco Dall'Anese, proposed offering free drugs to addicts as a way to compete with dealers. Squeezing in between the addict and the supplier to offer a cheap alternative would “break” the finances of drug pushers and “reduce demand,” he told the Spanish–language daily La NaciĆ³n.

“Here, what we would do is preempt the business of drug dealing,” he said.

The reasoning behind the proposal is fairly simple. By stopping the flow of income to drug dealers and eradicating the addict's need to steal in order to buy another fix, crime rates should drop.

This idea is not revolutionary. Countries in North America and Europe have used harm reduction techniques such as methadone clinics for years to treat heroin addiction.

These efforts have been regarded as successful in reducing crime and curving addiction by medical journals.

Dall'Anese's proposal, though, does represent a fundamental shift in Costa Rican drug policy, as providing addicts with free, chemical substitutes would take the drug addiction problem out of the hands of law enforcement and place it at the doorstep of public health officials.


Related Articles

Thursday, 17 December 2009

ACT Heroin Trial Revived?

The ACT and Federal governments are currently reviewing their drug policies for 2010 onwards. What’s most interesting is that the ACT is proposing once again, a trial of heroin assisted treatment (HAT) for long term drug addicts. The last attempt in 1997 had overwhelming bipartisan federal support and agreement from a majority of the states to move ahead but after continuous displays of moral panic and drug hysteria from the right wing press, little Johnny Howard vetoed the proposal. It was a sad day for Australia especially for the experts who had many years of intensive research flushed down the political loo.

Both the federal government and The ACT are calling for public input and it will be interesting to see what Kevvy will do if a heroin trial is proposed as part of their strategy. Maybe he might do what Denmark did and skip the trial altogether since there is enough evidence already that HAT is successful. Then again, most modern Christians like Kev oppose anything sensible that’s drug related. We will have to wait and see if Kev’s claim before the election to base policies on evidence, is true.

Public Input Critical To Make Drug Strategies Better
Canberra Times (page 17)
December 2009

Federal and ACT policies need a full and objective review, Brian McConnell writes.*

The ACT and Federal governments are reviewing their respective drug strategies and are seeking community input. The timing for seeking comments is unfortunate as many are in holiday mode. But if the community does not become engaged both drug strategies will just be more of the same.

That is drug overdoses, diseases and deaths; full jails; huge profits to black marketeers; more sensational headlines about “the biggest drug bust ever”, but effectively no real change.

And the vast bulk of funding going to the criminal justice system, despite evidence to the contrary that increased health and treatment provides a greater pay-off.

The ACT draft strategy 2010-2014 is generally a sound document with guiding principles that include: harm minimisation; applying evidence-based practice; and increasing access to services.

Harm minimisation is a three pillar policy adopted by all Australian governments which include supply reduction, demand reduction and harm reduction.

Generally it relates to the prohibition regime for illicit drugs but the ACT draft strategy applies the principle to all drugs.

Two potentially life-saving actions included in the ACT strategy are a national and local early warning system about drug purity and strength and a heroin trial.

Readers will recall that the heroin trial had been approved at a meeting of all health and police ministers in 1997, a decision that still stands. However the then prime minister John Howard vetoed the importation of the heroin necessary for the trial to be implemented.

The question of importation now needs to be put to the current Prime Minister Kevin Rudd. And given that overseas countries, which have adopted the practice of providing prescription heroin to the severely addicted, have experienced outstanding results in terms of reduced drug related crime, reduced drug use and reduced drug supply, it is questionable that a trial is necessary. Australia could follow Denmark’s lead, accept the evidence and move directly to implementation.

It is noteworthy that the ACT strategy proposes that police will have a target of increasing the number of arrests of drug providers (ie dealers). The past records show that increasingly the majority of arrests for drug offences were of consumers (ie 77 per cent in 2004-05, 82 per cent in 2005-06, and 87 per cent in 2006-07). Consumption of drugs is largely a health issue and therefore the target should include reduction of consumer arrests.

There are omissions from the ACT’s strategy that merit examination, there is correctly no mention of roadside drug testing in the strategy. There is little evidence of its cost-effectiveness, there is no base line as there is with alcohol, and the current tests are only available for a limited number of drugs that as yet, have not been shown to be the cause of significant road accidents.

The provision of “the same health services to prisoners as the general community”, although a public health and human rights issue, has not been brought forward from the previous strategy. An example is the provision of clean syringes to injecting drug-using prisoners. The facts are clear - drugs and syringes are shared in prisons and the ACT prison is no exception. The experiences in prisons in European countries with syringe exchange programs have been positive and free of major problems.

The objection to the program appears to come from the prison officers who fear that syringes could be used as weapons, stating the case of a prison officer in a NSW jail who was stabbed by an infected syringe by a mentally ill prisoner. The officer died as a result. But note that this happened even though syringes were banned. For prison officers, this is an unrecognised OHS issue. With controlled provision, officers would be safer knowing where every syringe was and that they were uncontaminated.

The most significant item missing from the strategy is a full and thorough evaluation of illegal drug policies, policies that have given rise to most of the problems we experience with illicit drugs.

Regulated and controlled, the black market and other problems would reduce significantly.

Most recently David Weisbrot former head of Australian Law Reform Commission had this to say about treatment of drugs:

“I think the war on drugs, using that kind of military approach and policing approach, has really failed communities all around the world, and you can see the fallout from it, not only in the statistics of people who have died, or had serious health ailments from their drug use, but also the way it's distorted the criminal justice system and ravaged many of our communities.”

No one’s family is immune from the ravages of drugs. Holiday mode or not, now is the time to become engaged and insist that a full and objective review of drug policies be included in both strategies.

Brian McConnell is President of Families and Friends for Drug Law Reform


Related Articles:
The Start of Prescription Heroin in Australia?
Survey: Heroin Trials in Australia
Who Supports a Heroin Trial?
UK Heroin Trials - Another Win For Prescription Heroin
Canada Provides the Final Proof Needed for Heroin Assisted Treatment
Germany Passes Prescription Heroin into Law
What Does Prescription Heroin Really Mean for Junkies?



Friday, 18 September 2009

UK Heroin Trials - Another Win For Prescription Heroin

A recent scientific trial of heroin assisted treatment (HAT) in the UK has again shown to be highly effective for treating long term addicts. This is just getting boring. Another heroin trial, another great result. How many trials are we going to have before governments accept the benefits of prescribing heroin to long term addicts?

It’s interesting to note (as far as I can tell), not one Australian major media outlet reported on the UK announcement. I understand that the Murdoch trash machine might ignore these results but what about the rest of the media? Why hasn’t Nicola Roxon or Uncle Kev been questioned on this as the rumour mill tells us a government drugs policy is due before Christmas? And just for fun, I thought at least one reporter would track down John Howard to see if his head has imploded yet.

Heroin Supply Clinic 'Cuts Crime'
By Danny Shaw - BBC Home Affairs Correspondent
BBC News


A scheme in which heroin is given to addicts in supervised clinics has led to big reductions in the use of street drugs and crime, the BBC has learned.

More than 100 users took part in the pilot - part funded by the government - in London, Brighton and Darlington.

They either injected heroin or received the drug's substitute methadone.

Those given heroin responded best and an independent panel which monitored the scheme over six months is advising ministers to set up further trials.

About three-quarters of those given heroin were said to have "substantially" reduced their use of street drugs.

Research suggests that between half and two-thirds of all crime in the UK is drug-related.

The Home Office says on its website that about three-quarters of crack and heroin users claim they commit crime to feed their habits.

PILOT SCHEME FINDINGS

•Three-quarters reduced use of street heroin
•Offences down from 1,731 in 30 days to 547 in six months
•Spending on drugs down from £300 to £50 a week Figures for group given heroin
•Professor John Strang, who led the project, said the results were "very positive" because the scheme had helped cut crime and avoid "expensive" prison sentences


Professor Strang, who is based at the National Addiction Centre, part of King's Health Partners, said the individuals on the programme were among those who had been the hardest to treat.

"It's as if each of them is an oil tanker heading for disaster and so the purpose of this trial is to see: 'Can you turn them around? Is it possible to avert disaster?'

"And the surprising finding - which is good for the individuals and good for society as well - is that you can," he said.

The Randomised Injecting Opioid Treatment Trial (RIOTT) programme - which is funded by a number of agencies, including the Department of Health - began in 2005.

It involved 127 chronic heroin addicts for whom conventional types of treatment had failed.

Many of the addicts were also using other substances, including crack cocaine.

During the trials, a third of addicts were given the heroin substitute methadone orally and another third injected methadone under supervision.

The remainder, observed by nurses, injected themselves with diamorphine - unadulterated heroin - imported from Switzerland.

National roll-out?

Those on the programme were also given psychological support and help with their housing and social needs.

The results showed that addicts in all three groups cut the amount of heroin they obtained illicitly from street dealers.

According to researchers, more than half of the heroin injecting group were said to be "largely abstinent" and one-in-five did not use street heroin at all.

Before they began the programme, the addicts in the heroin injecting group were spending more than £300 a week on street drugs. After six months, this had reduced to an average of £50 a week.

“ It used to be about chasing the buzz, but when you go on the programme you just want to feel comfortable ”
John, RIOTT participant
There was also a big drop in the number of offences addicts admitted committing to obtain money to feed their habit.

In the previous month before the scheme started, addicts in the heroin injecting group reported carrying out 1,731 crimes.

After six months, this had fallen to 547 offences - a reduction of more than two-thirds.

One of the heroin addicts on the programme, a 34-year-old man called John, had been addicted for eight years when the trials began. He fed his habit by dealing.

"My life was just a shambles... waking up, chasing money, chasing drugs," he said.

But John said the scheme had transformed his life "100 per cent" and he now had a part-time job.

"It used to be about chasing the buzz, but when you go on the programme you just want to feel comfortable," he said.

"I've started reducing my dose gradually, so that maybe in a few months time I'll be able to come off it altogether, drug free totally."

In its drug strategy, published last year, the government said it would "roll out" the prescription of injectible heroin, subject to the findings of the pilot scheme.

The National Treatment Agency for Substance Misuse (NTA), which administers drug treatment in England, said the results were "encouraging".

The NTA said an independent expert group, set up to advise the government, had concluded that there was enough "positive evidence of the benefits" of the programme to merit further pilots.

The NTA is understood to be keen to evaluate the financial implications of the scheme. At £15,000 per user per year, supervised heroin injecting is three times more expensive than other treatments.



Related Articles:
Leading Article: An Injection Of Common Sense
Canada Provides the Final Proof Needed for Heroin Assisted Treatment
Germany Passes Prescription Heroin into Law
Heroin Assisted Treatment Winning Approval in Europe
What Does Prescription Heroin Really Mean for Junkies?
Denmark - More Prescription Heroin Programs for Addicts
Prescription Heroin - Lifesaving Medication?
Top UK Cop Calls for Prescription Heroin
How Much Evidence Do We Need?
Israel - Another Country Considers Prescription Heroin
Who Supports a Heroin Trial?



Wednesday, 26 August 2009

Canadian Gov Reneges on Funding for 2nd Phase Heroin Trials (SALOME)

I had just finshed writing about the success of the latest study by the North American Opiate Medication Initiative (NAOMI) when I stumbled on a news article titled, “Rehab centre upset after Quebec pulls funds for heroin study”. Slightly confused, I quickly read the article and discovered that the fucked up Harper government in Canada were again playing god with people’s lives and putting their ideology before science. Just days after the New England Journal of Medicine published the positive results for Canada’s latest heroin trial, the Harper Government has pulled funding for the second phase of the study called SALOME.

What is the NAOMI clinical trial? (Phase 1)
The North American Opiate Medication Initiative (NAOMI) was a randomized trial aimed at testing whether medically prescribed diacetylmorphine, the active ingredient in heroin, was more efficient than methadone therapy for individuals with chronic opioid dependence who were not benefiting from other conventional treatments. The results show that patients treated with injectable diacetylmorphine were more likely to stay in treatment and more likely to reduce their use of illegal drugs and other illegal activities than patients treated with oral methadone.
-SALOME Clinical Trial Questions and Answers

What is the SALOME clinical trial? (Phase 2)
The Study to Assess Longer-term Opioid Medication Effectiveness is a clinical trial that will test whether diacetylmorphine, the active ingredient of heroin, is as good as hydromorphone (Dilaudid®), a licensed medication, in benefiting people suffering from chronic opioid addiction who are not benefiting sufficiently from other treatments. Also, this study will test if those effectively treated with these 2 injectable medications can be successfully switched and retained to the oral formulations of the medications.
-SALOME Clinical Trial Questions and Answers

It has always surprised me that the conservative Canadian government actually agreed to fund this study but to pull out as soon as the first study produced such positive results raises my suspicions. Were they expecting the trial of heroin assisted treatment (HAT) to fail? Was the promise to fund the 2nd phase just empty rhetoric with the expectations that they would never have to fund part two of a failed study? Considering that the government has just recently introduced new harsher laws for small time drug users including mandatory sentencing and the success of the latest heroin trials, how can we not be suspicious of the Harper Government’s motives.


Rehab Centre Upset After Quebec Pulls Funds For Heroin Study
The Gazette
By Aaron Derfel
August 2009

A Montreal drug-treatment centre is accusing the provincial government of playing politics in killing funding for a three-year study to treat heroin addiction.

The cancellation of the $600,000 grant follows the publication this week of a study showing that giving heroin to hard-core addicts at the centre's supervised clinic leads to higher rates of recovery.

"We're very surprised because all the discussions that we had with the (Social Services) minister in the last few weeks were very positive," said Eric FabrĆØs, the centre's co-ordinator of quality services. "We can't understand why the minister has changed her position. ... But we find it very peculiar that at the moment that we published the results in the New England Journal of Medicine, the minister decided to withdraw her support from the project."

The study, titled the North American Opiate Medication Initiative (NAOMI), sought to analyze whether heroin-assisted therapy offers more benefit to addicts who want to kick their habit than standard methadone treatment.

The researchers monitored 251 addicts in Montreal and Vancouver. In Montreal, addicts were given heroin at the Centre de recherche et d'aide pour narcomanes.

The study found that among addicts who received heroin by injection, 88 per cent completed the recovery program, compared with a 54-per-cent completion rate for those who took oral methadone.

But researchers also discovered that 10 per cent of addicts who took Dilaudid, a legal prescription opiate known as hydromorphone, did as well as those on heroin.

For the second phase of the research, titled SALOME (Study to

Assess Longer-term Opioid Medication Effectiveness), scientists wanted to compare heroin and Dilaudid for a three-year period.

The rationale is that if Dilaudid is truly as good as heroin in helping diehard addicts recover, it would solve the legal problem of having to use heroin, FabrĆØs said.

"But without the funding, the project is dead," he added.

GeneviĆØve Trudel, political attachĆ© to Social Services Minister Lise ThĆ©riault, said the decision to cancel the grant was simply cost-cutting.


Related Articles:
Canada Provides the Final Proof Needed for Heroin Assisted Treatment
Quebec's landmark heroin study in jeopardy
SALOME: Clinical Trial Questions and Answers

Sunday, 23 August 2009

Canada Provides the Final Proof Needed for Heroin Assisted Treatment

Once again, a trial of prescription heroin for long term addicts has proven to be superior to other treatments including Methadone Maintenance Treatment(MMT), buprenorphine and abstinence programs. The results of the study from the North American Opiate Medication Initiative (NAOMI) in Canada has been eagerly awaited as the final proof that heroin assisted treatment (HAT) is indeed a viable and effective solution. Of course, it’s just conversation unless more countries implement it as part of their drug treatment policy & health plans. I especially want the Australian government to look at the evidence and continue on from where the ACT trials abruptly ended. There’s no John Howard anymore to veto an almost unanimous decision and no Major Brian Watters to misrepresent the ANCD. More importantly, there is now more evidence than ever before and a almost universal acceptance that HAT is the most effective treatment for long term heroin addiction.
Study Backs Heroin to Treat Addiction New York Times By Benedict Carey August 2009 The safest and most effective treatment for hard-core heroin addicts who fail to control their habit using methadone or other treatments may be their drug of choice, in prescription form, researchers are reporting after the first rigorous test of the approach performed in North America. For years, European countries like Switzerland and the Netherlands have allowed doctors to provide some addicts with prescription heroin as an alternative to buying drugs on the street. The treatment is safe and keeps addicts out of trouble, studies have found, but it is controversial — not only because the drug is illegal but also because policy makers worry that treating with heroin may exacerbate the habit. The study, appearing in the current issue of the New England Journal of Medicine, may put some of those concerns to rest. “It showed that heroin works better than methadone in this population of users, and patients will be more willing to take it,” said Dr. Joshua Boverman, a psychiatrist at Oregon Health and Science University in Portland. Perhaps the biggest weakness of methadone treatment, Dr. Boverman said, is that “many patients don’t want to take it; they just don’t like it.” In the study, researchers in Canada enrolled 226 addicts with longstanding habits who had failed to improve using other methods, including methadone maintenance therapy. Doctors consider methadone, a chemical cousin to heroin that prevents withdrawal but does not induce the same high, to be the best treatment for narcotic addiction. A newer drug, buprenorphine, is also effective. The Canadian researchers randomly assigned about half of the addicts to receive methadone and the other half to receive daily injections of diacetylmorphine, the active ingredient in heroin. After a year, 88 percent of those receiving the heroin compound were still in the study, and two-thirds of them had significantly curtailed their illicit activities, including the use of street drugs. In the methadone group, 54 percent were still in the study and 48 percent had curbed illicit activities. “The main finding is that, for this group that is generally written off, both methadone and prescription heroin can provide real benefits,” said the senior author, Martin T. Schechter, a professor in the School of Population and Public Health at the University of British Columbia. Those taking the heroin injections did suffer more side effects; there were 10 overdoses and six seizures. But Dr. Schechter said there was no evidence of abuse. The average dosage the subjects took was 450 milligrams, well below the 1,000-milligram maximum level. About 663,000 Americans are regular users of heroin, according to government estimates. The researchers said 15 percent to 25 percent of them were heavy users and could benefit from prescription heroin. That is, if they ever were to get the chance. Heroin is an illegal, Schedule 1 substance, meaning it has a high potential for abuse and serves no legitimate medical purpose. That designation is unlikely to change soon, researchers suspect. In an editorial with the article, Virginia Berridge of the London School of Hygiene and Tropical Medicine concluded, “The rise and fall of methods of treatment in this controversial area owe their rationale to evidence, but they also often owe more to the politics of the situation.”

Saturday, 30 May 2009

Germany Passes Prescription Heroin into Law

For years Germany has endured criticism and warnings about their heroin trials from the outdated International Narcotics Control Board (INCB) and the United Nations Office on Drugs and Crime (UNODC) Yesterday, the German parliament essentially snubbed the warnings and voted to include heroin assisted treatment (HAT) as part of their official drug policy. Since the INCB condemns drug addiction and expressly forbids HAT, Germany had to previously conduct their heroin trials using a special clause for scientific research. Article 4 of the Single Convention on Narcotic Drugsrequires nations to limit use and possession of drugs to medicinal and scientific purposes”. It’s the same clause that the Sydney Medically Supervised Injecting Centre (MSIC) has had to operate under for the last 10 years. All of the countries conducting heroin trials or with MSIC programs have come under relentless criticism from UNODC and the INCB including threats. Australia backed out of a heroin trial after US diplomats and the INCB threatened the Tasmania poppy industry. Luckily for many European countries, the UN/US do not have any bargaining chips to threaten them with. Recently, Switzerland and Denmark both ignored the Single Convention on Narcotic Drugs and passed HAT into law. Now Germany has joined them.

Is this the beginning of the end for the US/UN dominance over worldwide drug policies? Will this lead to Canada and Spain - who had very successful heroin trials - to establish HAT at the risk of upsetting the US/UN? What about Australia? What about the UK who already have the capacity to prescribe heroin to addicts and are currently finishing off a very successful heroin trial? Will common sense, evidence based research and this growing trend finally tip over the various governments who have considered HAT? With HAT now showing more success than abstinence only treatment, methadone, buprenorphine and Suboxone for long term users, it’s going to be hard for governments to reject. That’s the theory anyway.

German Addicts To Get Synthetic Heroin As Prescription Drug

Earth News

May 2009

Berlin - Long-term drug addicts in Germany will soon be able to obtain synthetic heroin on prescription, under a new law approved by parliament on Thursday. Thousands of addicts are expected to benefit from the legislation reclassifying diamorphine as a legally prescribed controlled drug.

Under the terms of the law, addicts aged 23 or older will be able to obtain diamorphine on prescription at special centres and take it under the supervision of trained personnel.

The programme will apply only to people addicted to opiates for more than 5 years who have unsuccessfully taken parts in rehab programmes at least twice.

The legislation follows a pilot project conducted on more than 1,000 addicts in seven German cities between 2002-2006.

The study showed the health of addicts who took diamorphine improved more frequently than it did for those treated with the heroin substitute methadone.

A spokesman for Chancellor Angela Merkel's conservative, who opposed the legislation, warned that up to 80,000 addicts could take advantage of the new scheme, while drug experts put the figure at 2,000 to 3,000.

Related Articles:

What Does Prescription Heroin Really Mean for Junkies?

Another Successful Heroin Trial - Canada

Prescribed Heroin Project 'Promising'

Heroin Assisted Treatment Winning Approval in Europe

Denmark - More Prescription Heroin Programs for Addicts

Who Supports a Heroin Trial?

All articles on prescription heroin

Wednesday, 25 February 2009

Heroin Assisted Treatment in a Pill

Although heroin assisted treatment (HAT) and the many heroin trials have all been very successful, it is still not the perfect solution. Having to visit a clinic 2-3 times a day and the problems associated with injecting are the 2 main obstacles for patients. Some smart cookie in Canada though has come up with a fantastic idea that might go a long way to treating hard core addicts without these obstacles. Heroin in a pill.

The idea of providing morphine, heroin or hydromorphone to hard core addicts is not new and when put into practice has had great success. Sadly though, through blind ignorance, selling the proposal that drug addicts are given addictive drugs legally to inject has not been easy with the media often whipping up a storm of drug hysteria and governments scared of a public backlash. Supplying the drugs via a pill may be the answer. Fear of take away supplies being diverted to the black market would still be a major concern for many so there would need to be a strict monitoring system in place. It is achievable though with a well thought out system. Diversion though, in the real world becomes less of an issue when this simple question is asked:


Why would patients sell their high quality, legal heroin? ... to buy low quality street heroin?

Methadone may be the default treatment but it certainly has it’s problems. As someone who has been on methadone, buprenorphine and Slow Release Oral Morphine (SROM) to treat my heroin addiction, I can testify to the superiority of a morphine pill. Methadone often leaves the patient ‘flat’ which usually doesn’t happen when given drugs like Morphine. For those who don’t respond to methadone, detox. or rehab, having more options can only be beneficial. Once we start getting serious about treating addiction without the accrued bias from years of misinformation, morphine, heroin or hydromorphone in a pill becomes attractive. With strict guidelines, therapy/counselling and close monitoring, we might finally begin to help those long term users who don’t respond to current treatments and continue to use street drugs.


Can Pill Replace Heroin For Addicts?
CTVBC
Febuary 2009
Video report from CTV British Columbia's Maria Weisgarber


Researchers behind a controversial approach to Vancouver's drug problem are trying to launch a new study.

Hundreds of people took part in the NAOMI project, which stands for North American Opiate Medication Initiative. The project provided drug addicts with heroin, methadone and a pain medication called Dilaudid.

Rob Vincent took part in NAOMI. He says his health improved and he was able to work.

"I didn't have to worry about waking up in the morning and worry about where I'm going to come up with the money to get better now," he said.

Now there's a proposal for a similar study, called SALOME (Study to Assist Longer Term Opiod Medication Effectiveness) which would eventually test whether injectable drugs could be replaced with a pill.

"If you could get some people onto oral medication they could be treated much more simply," said Dr. Martin Schechter, a former NAOMI researcher.

The province has called NAOMI's results promising -- but says it's waiting for peer-reviewed published findings. Meanwhile, research advocates hope Tuesday's budget will include money for an international research treatment centre in BC.

"We have world class leading expertise here in Vancouver today," says Trish Walsh with the Inner Change Foundation. "We're just not giving them the tools to do the job."

The NAOMI project ended up finding pain medication worked just as well as heroin. But Dr. Schechter says when the three year study ended, so did the benefits for many of the participants.

"What we've learned is some of the people...a significant proportion of the people that were doing well subsequently relapsed in the first six months," he said.

Rob Vincent relapsed more than once.

"If you're going to make a project such as that where you're going to get everybody's hopes up...at least make it so it's continuous, and if you are going to have a cut-off date, have some sort of back-up, so that they're not just being thrown out back onto the street," he said.

The new project being proposed is another three year study.


Tuesday, 2 December 2008

What Does Prescription Heroin Really Mean for Junkies?



Switzerland has just become the first country to include prescription heroin as part of official government policy after a referendum voted 2 to 1 in favour of it. Although the 1300 patients who already receive prescription heroin in Switzerland are breathing a sigh of relief, what does it mean to addicts worldwide? Will other countries follow suit and if so, what will be the criteria to be accepted into the program? 


Also heroin trials to date have focussed on one or maybe two cities in each country so that leaves the vast majority of addicts not able to participate until the trial is either extended to cover other locations or it becomes government policy like Switzerland.

Swiss Approve Prescription Heroin BBC 
 
(mmmmm . . . look at all that heroin!)
Swiss voters have backed a change in health policy that would provide prescription heroin to addicts. 
Final results from the national referendum showed 68% of voters supported the plan. The scheme, where addicts inject the drug under medical supervision at a clinic, began in Zurich 14 years ago before spreading across the country. But in another referendum, the Swiss appear to have rejected the decriminalisation of cannabis. 
The heroin vote was one of a series of referendums held to decide policy on illegal drugs. The policy is described as one of last resort - prescribing addicts with the very drug that caused their problems in the first place - but supporters say it works, and Swiss voters appear to have agreed, the BBC's Imogen Foulkes in Berne says. Switzerland would be the first country to include it in government policy. 
Supporters say it has had positive results - getting long-term addicts out of Switzerland's once notorious "needle parks" and reducing drug-related crime. 
Opponents say heroin prescription sends the wrong message to young people and harms the addicts themselves.
Firstly though, congratulations to the Swiss for leading the world in common sense and pragmatic health policies. The world owes a lot to the Swiss (and the Dutch) for having the courage to care more for their people than pleasing the United States or hysterical religious groups. 


Secondly, we shouldn’t forget that this is the second attempt at trying something new. The first project, dubbed Needle Park was a failed experiment but it was still recognition that treating addiction with strict law enforcement wasn’t working. 


There have been several heroin trials now and all with very positive results. Even though they have all been successful, only 2 trials have developed into more permanent programs. One in Switzerland and the other in The Netherlands. Spain, Germany, Belgium and recently Canada have all held heroin trials with the UK’s trial finishing shortly. Also Denmark has announced they will be commencing a 2 year trial with a few other countries toying with the idea. 


Whilst many heroin addicts must be relieved to hear the good news of an ever expanding prescription heroin trend, the reality is not as rosy as it seems. Geographically, it is impossible to include everyone in a trial which is not the objective anyway. Most trials last about 2-3 years and for a program to be approved and operated in other cities, it may be 4 or more years away. Then you have to qualify them. At the moment, trials are for hard core, long term addicts who have failed other treatments and continue to participate in risky behaviour. I think the general consensus is that only the homeless or really desperate addicts will get in on the trials but established heroin assisted treatment (HAT) programs encompass other long term users more readily. But what about those functioning heroin addicts with jobs who appear to live a relatively stable life? Are they eligible? 


This site has shown many functioning addicts who remain outside the law by using and/or selling an illegal substance and are kept in a world of shame by hiding profound issues from their families. The binding thread is that they have all failed repeated attempts at treatment. Will they ever be included in a program for prescription heroin or are they not considered ‘desperate’ enough. A cynic could argue that these addicts might be excluded because they won’t contribute to the success statistics of such a program when there’s no room for improving key issues like homelessness, employment and health. A slap in the face really for those addicts who have been strong enough to stay employed or healthy whilst living with the nightmare of addiction.




As an addict in Vancouver for 38 years I was certain I would have no problem attending the program. It seems they only took Downtown addicts which gave them a very limited demographic and my calls went from wait to forget it. You could contact the NAOMI people if you want info but you'll be searching through an unpublished project.I hope you discuss parameters as most trials make getting off of heroin a prerequisite, which kills the project as you may well imagine. Harm reduction and working and happy clients should be the goal.Don't let them set you up to fail. [...] In my case I offered to move to the moon if transport was available. They seemed to have some issue with my actually having a roof over my head. They seemed to think that if you had it together enough to actually pay rent you didn't need a maintenance program. 
-Terry McKinney. Vancouver BC
I imagine some addicts would consider changing their lives dramatically if prescription heroin was available but not where they live. The opportunity to receive clinical grade heroin as part of their treatment is a huge temptation which I can testify to. Although prescription heroin may have been perfect for myself a few years ago, I am happy on my current treatment. The idea of injecting daily again or having to visit a clinic twice a day doesn’t appeal to me currently and it’s bound to be the same for other recovering addicts on substitution treatment. That’s if we were eligible at all.

HAT will expand over the next decade as it’s success becomes more accepted by governments frustrated over current drug policies and so will the requirements for entry into the programs.

Heroin is basically non toxic and users are able to lead relatively normal lives if they don’t have to deal with the consequences of it’s illegality. Most of the problems associated with heroin addiction are purely because of man made laws and not the drug itself. Issues like the spread of blood borne disease (Hep C, HIV/AIDS etc.), crime, health, employment and social exclusion are recent problems caused solely by treating this medical condition as a law and order issue.

Before the 1960s, some countries already treated opiate addiction with either morphine or heroin and there were very few problems. Back then, a great proportion of addicts eventually weaned themselves off opiates and went back to their normal lives, often over a 5-7 year period which is sometimes called the natural addiction cycle. It’s ironic that in this age of advanced technology and medicine, we are starting to revert to treatments from over 50 years ago.

On a sad note, there are many who criticise HAT for all sorts of reasons except those that count. There’s the “sending the wrong message” argument and the “we should be getting them off drugs” excuse. These are all just philosophical opinions that have no bearing in the real world and are just placing the morals of drug use above the health and well being of someone with a medical issue. Associated Press reported that one opponent of the Swiss decision, Sabine Geissbuhler from Parents against Drugs was so adamantly opposed to the program that she publicly stated:

I would never, never, put my children into a heroin prescription programme. What kind of freedom is that? I'd rather they were dead -Sabine Geissbuhler - Parents against Drugs


Releated Links: 
Swiss vote on radical heroin rules 
Swiss likely to approve prescription heroin

Monday, 20 October 2008

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?