Opiate trial results are encouraging
We have to overcome our squeamishness and start using what works for addiction
Vancouver Sun Editorial
Published: Wednesday, October 22, 2008
Although heroin maintenance might appear to be a daring new treatment for heroin addicts, it's neither daring nor new.
Indeed, the United States, of all countries, ran narcotic maintenance programs until 1925, and the United Kingdom engaged in opiate maintenance for much of the 20th century.
Given the success of Britain's programs, many other European countries, including Switzerland, Germany, Spain and the Netherlands, have conducted scientific studies on the efficacy of opiate maintenance, and have found that it has had significant positive outcomes for both addicts and their communities.
And now the results of the North American Opiate Medication Initiative (NAOMI) are in. The initiative involved 251 volunteers (192 in Vancouver and 59 Montreal) who were chronic opiate addicts.
The volunteers were, on average, 40 years old, and had been injecting drugs for an average of 16.5 years. Participants injected an average of four or five times a day, had a median of seven previous drug treatment attempts including a median of three methadone treatment attempts, and an average of four overdoses. Nearly one-third of the volunteers had attempted suicide.
In other words, the subjects were among the most chronic and marginalized of addicts, the people who have failed to respond to other treatments and who often have the most trouble accessing health and social services.
The investigators, led by Martin Schecter, director of the school of population and public health at the University of British Columbia, divided the subjects into two groups. The first group received heroin for a 12-month period, while subjects in the second were given methadone pills.
The results were most promising: 88 per cent of those receiving heroin and 54 per cent of those on metha-done stayed with the program. These are impressive retention rates given the chronic nature of the subjects' addiction, and the results for the heroin group are especially promising.
Further, illicit heroin use dropped by nearly 70 per cent, the number of subjects involved in illegal activities fell by almost half, and subjects reported significant improvements in both their physical and mental health. And those in the heroin group did particularly well, often significantly better than those receiving methadone.
Finally, despite some concerns before the start of the study, there were no negative effects on neighbourhoods surrounding the clinics where the study was conducted.
This reveals that opiate maintenance, in particular, heroin assisted treatment, can be good for both addicts and the communities in which they live. And it suggests that we should consider funding such treatment, at least for those hard to treat addicts who have failed to respond to other therapies.
That's easier said than done given the stigma associated with heroin, and given the federal government's hostility to new and even not so new treatment modalities. This is unfortunate, but it is a reality.
And given that, there may be another solution. A small number of subjects in the heroin group actually received hydromorphone (Dilaudid), a potent opiate used in cough medicines, and performed just as well as those receiving heroin. Since hydromorphone doesn't have the same stigma as heroin, it might provide a real alternative.
Of course, we should ultimately provide whichever treatments work best, and that would likely include heroin for those who don't respond to methadone or hydromorphone.
If we really want to solve the problem, we need to overcome our own squeamishness, and support therapies that are proven to improve the lives of addicts and their communities.
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