Methadone Rehabilitation

In Vancouver, a pilot program was started in 2005 (the first of its kind in North America) assessing the efficacy of heroin assisted treatment among hard-core drug users. This type of study, which has been previously conducted in parts of Europe, proposed to solve severe drug problems afflicting portions of major cities throughout Canada. While many long-term opioid addicts respond positively to methadone treatment, a smaller segment of the heroin addicted population, for reasons unknown to sociologists and psychologists alike, refuse to cease their IV drug use despite conventional rehabilitation efforts or maintenance therapy. It is this portion of the heroin using population that NAOMI (North American Opiate Maintenance Project), the pilot program mentioned above, sought to address.

The study included approximately 450 confirmed heroin addicts, all found to be resistant to methadone maintenance, who were granted governmental access to either legal heroin, hydromorphone (Dilaudid) and heroin alternating, or methadone. The segment that received methadone was selected to serve as a control group so that data could be more accurately recorded and compared. Because it was a “double blind-folded” study, at the beginning of the project, none of the three groups knew which drug they would be receiving. NAOMI was conducted in the notorious drug infested sector of downtown Vancouver known as the “downtown east-side”. It lasted for about one year and, like many other investigations of its kind, was found to not only reduce HIV and hepatitis infection rates and drug related crime, but also to help reintegrate hard-core drug addicts into mainstream society by taking their focus away from seeking drugs. These results were much more pronounced in the group receiving heroin (and/or hydromorphone) than in those receiving methadone.

In addition, an unexpected result was found. Most of the individuals given alternating injections of heroin and hydromorphone were not able to distinguish between the two. It was this piece of data that inspired the conception of SALOME (Study to Assess Longer-Term Opioid Medication Effectiveness), a second study intending to not only further investigate the effects of heroin maintenance therapy, but to determine whether or not hydromorphone will prove to be just as effective as heroin in treating this particular segment of the drug using population.

SALOME is scheduled to take way in the first half of 2010 and will recruit 322 hard-core heroin addicts over a three week application period. Participants are required to have been dependent on heroin for at least 5 years and have failed an attempted methadone maintenance program at least once. The trial will continue for approximately one year just like NAOMI, and will consist of two separate study phases. During phase one, half of the participants will receive injectable heroin (diacetylmorphine) and the remaining half will receive injectable hydromorphone (Dilaudid). Because the study will be “double blind-folded”, neither group will know which of the two drugs they are receiving throughout the trial. After the data is collected and results recorded, the completion of phase one will give way to phase two in which half of each group will be switched to an oral formulation of their assigned drug. The purpose of phase two is to evaluate the success rate of already stabilized patients taking their medication in the less stigmatized manner of oral ingestion as compared to intravenous injection. Researchers are hoping to minimize injection rates among hard drug addicts, such as those addicted to heroin and cocaine.

Although the trial was initially projected to take place in both Vancouver and Montreal, Quebec provincial authorities dismissed the possibility of such a study taking place in Montreal by refusing to fund it. Since this was made clear, SALOME researchers have officially announced that that the project will be conducted in Vancouver only. This is an appropriate location for such a study given that Vancouver is home to North America’s most prominent open hard drug scene and its only safe injection site known as “Insite”. While within the confines of “Insite”, drug addicts are no longer subject to law enforcement regarding controlled substances and can therefore possess and use “illegal” drugs without concern for arrest. This makes it much easier for researchers who can successfully undertake this sort of trial without having to worry about government officials and legal restrictions.

Upon completion, research scientists launching the project are hoping to verify the results they collected from NAOMI, Canada’s initial study assessing the outcome of medically prescribed heroin for heavily dependent opioid addicts. Moreover, SALOME is taking place to determine whether or not an injectable opiate more socially accepted and less stigmatized than heroin, namely hydromorphone, can be used in its place with the same positive results. If this proves true, because of its current legal status, hydromorphone would have a much better chance of gaining government approval for utilization in opioid replacement therapy for those who have failed at conventional maintenance treatment programs in Canada.

For more information regarding addiction treatment and the brain, Lester De Vine would like to invite you to take a look at the following web pages:

http://www.squidoo.com/opioid-replacement-therapy-

http://hubpages.com/hub/Heroin-Maintenance-Treatment-In-Europe

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