OTTAWA — A Canadian study that found giving heroin to hardcore drug addicts at a supervised clinic leads to a higher rate of recovery than giving them methadone was published Thursday in the prestigious New England Journal of Medicine.
The study, titled North American Opiate Medication Initiative (NAOMI), studied whether heroin-assisted therapy benefits people who suffer from opiate addictions. The study was released in October 2008, but was not published until Thursday.
The NAOMI report concluded that injecting addicts with diacetylmorphine, the active ingredient in heroin, was more effective than oral methadone.
Canadian scientists monitored 251 drug addicts in Montreal and Vancouver, the two cities with the largest heroin-addicted populations in Canada. The participants got drugs for 12 months under the supervision of nurses, doctors, psychiatrists and social workers.
During the trial, 115 addicts received the medical heroin, 111 received methadone and 25 received hydromorphone — a licensed opiate for pain relief — starting in March 2007.
The study found that those on the diacetylmorphine had an 88 per cent better chance of kicking the habit, compared to 54 per cent in the methadone group. Further, the reduction in rates of illicit-drug use or other illegal activity was 67 per cent in the diacetylmorphine group and nearly 48 per cent in the methadone group.
Dr. Martin Schechter, one of the lead researchers of the study, said the publication of their work "feels like a vindication" of the criticism the study has received. One such criticism was speculation that addicts may report false results to increase their chance of more free drugs in the future.
"The New England Journal of Medicine is one of the most prestigious journals in the world and it's a validation of the quality of the scientific work we have done," he said. "It puts the best seal of approval on a study and that does have an affect on policy-makers."
Schechter said an editorial in the journal points out that giving addicts heroin is not a new idea and that the method has resurfaced in Europe and now North America.
Following NAOMI, a further study was announced in June called SALOME — Study to Assess Longer-term Opioid Medication Effectiveness. Schecter, who will be also involved in that study, said they are currently trying to secure funding for the project. The SALOME will give more than 200 addicts in Montreal and Vancouver heroin treatment in pill and injectable forms.
With the new study, scientists hope to prove that hydromorphone is just as effective as prescribing heroine to treat addicts. Schechter said the addicts given the hydromorphone could not tell the difference from heroin.
"It would be effective where heroin is a non-starter because of political reasons, for example (in) the United States where they would use a licensed opiate for pain," he said. "If we could prove this, then it could be licensed for addiction."
In the editorial in Thursday's Journal, Virginia Berridge says the findings of the Canadian study are widely supported in Europe, but have not been in the United States. The Australian government discontinued a heroin trial in the 1990s.
"The results of this trial may be added to those from Germany, the Netherlands, Spain and Switzerland," Berridge said. "Switzerland has 10 years of experience in the prescription of heroin, and in a November 2008 referendum, 68 per cent of voters were in favour of its continued prescription."
Meantime, the Harper government opposes Insite, a Vancouver-based facility that allows drug users to inject heroin and cocaine under medical supervision, and is embroiled in a legal battle to shut it down. The site, which opened in 2003, is supported by local and provincial governments.
The federal government argues money should not be spent on drug use, instead directing funds toward prevention and treatment of substance addiction.
By Tiffany Crawford
August 19, 2009
Canwest News Service
Heroin Better Than Methadone for Treating Addiction