When all else fails, there's free heroin

The federally and locally funded research targets addicts who have been through addiction-treatment programs and heroin-substitute methadone therapy but have remained severely addicted to heroin.

"The treatments we have been providing have failed to keep these people far from drugs," said Eugenia Oviedo-Joekes, a lead SALOME investigator who came to St. Paul's Hospital after conducting free-heroin research in Spain. "We have been defeated by reality, at least for today."

For hard-core addicts who can't quit, society is left with the choice of letting them lead miserable lives which cost taxpayers dearly, or trying to find a solution that minimizes the damage and provides some hope of improving their lives, Oviedo-Joekes said.

"We aim for the poor guys that have been left behind by society, by the health-care system," she said.

The federal Canadian Institutes for Health Research has given approval to SALOME, and is expected to contribute $1 million. B.C.'s Providence Health Care, a Quebec provincial health authority and private donors will provide the rest of the funding.

Two successful businesspeople and another philanthropist have committed $500,000 for the research, said Trish Walsh, executive director of the Inner Change Foundation, which is raising money for SALOME. Former Tory MP John Reynolds sits on the SALOME board.

"There's tremendous

interest in looking for an effective solution to the Downtown Eastside," Walsh said.

The project appeals to people across the political spectrum because it produces measurable results and carries the hope of reducing the economic costs addiction imposes on society, Walsh said.

SALOME follows NAOMI (North American Opiate Medication Initiative), which also gave addicts substitutes for street heroin.

In NAOMI, 115 addicts in Vancouver and Montreal received medical heroin, 111 received methadone, and 25 received Dilaudid, starting in March 2007. The study found addicts on the medical heroin had more success with staying in treatment or kicking drugs entirely -- 87 per cent -- than those on methadone, with a 54-per-cent success rate.

But those on Dilaudid, at 88 per cent, did even better.

The number of participants committing crime dropped from 70 per cent to 36 per cent, and the amount of money they spent on street drugs dropped by almost half, according to the study.

Participants' health indicators improved 27 per cent.

A NAOMI participant, Jennifer, said she'd started using heroin after her twin 12-year-old boys and husband died in a boat explosion, and she also began smoking crack and working as a prostitute. After NAOMI, in which she received Dilaudid, she cut her illegal drug purchases from $3,000 a month to $200, quit sex work and got into a methadone program, she said.

Critics charged that NAOMI's results were unreliable because they came from addicts' self-reporting.

A group of 26 Canadian addictions doctors authored a critique of the NAOMI trial's design and interpretation of results, stressing that there were several adverse reactions in the Dilaudid group. They concluded "the establishment of hydromorphone injection clinics in B.C. is premature. Such a clinic will be expensive and of unproven efficacy and safety, and it may result in hydromorphone . . . abuse."

University of Toronto addictions specialist Dr. Meldon Kahan believes the NAOMI trials set up methadone treatment to fail, using low doses and providing poor supports.

"NAOMI advocates claim their treatment is intended for patients who have failed at methadone treatment, and therefore the choice is between free heroin or street heroin," Kahan said. "But in fact NAOMI patients did not receive high-quality methadone treatment, with optimal dosing and counselling."

It costs $7,500 a year to treat an addict under the NAOMI and SALOME models, whereas health and legal-system costs for addicts in general run at $50,000 a year, said NAOMI lead investigator Martin Schechter.

SALOME researchers hope to find out if Dilaudid can accomplish what prescribed heroin did, making it easier to fund and run Dilaudid-based treatments, which don't carry the stigma of heroin. Researchers also want to discover whether orally taken heroin and Dilaudid can work as well as injected formulations, to cut needle-use risks.

Additional goals of SALOME include reducing illicit drug use, cutting the profits of organized crime, improving health, reducing addiction-related theft and, if possible, getting participants to conquer their addictions.

"Our aim is that you can function," Oviedo-Joekes said, "that you can get a roof, that you can be back working, if you can, that you can have bonds with the community, if you can, that if you're mentally ill, that you can get [professional] attention."

-- with a file from Elaine O'Connor