Vancouver Study Claims Benefits to Prescribing Heroin

By chillinwill · Oct 30, 2008 · Updated Nov 1, 2008 · ·
  1. chillinwill
    But Critics Say the Efforts Amount to a Dangerous Step Toward Legalizing Drugs.

    Vancouver, British Columbia - Every morning for a year, Rob Vincent walked into a clinic on the edge of Vancouver's roughest neighborhood, rolled up his sleeves and injected pharmaceutical heroin.

    Each time, Mr. Vincent played the role of guinea pig in a controversial, three-year, government-funded experiment that supporters hope will change the face of addiction treatment in this picturesque but drug-riddled western port city.

    The findings of the North American Opiate Medication Initiative, or NAOMI, were released here on Oct. 17 and the results, researchers say, are "remarkable."

    "Heroin-assisted treatment ( HAT ) is very safe when done properly," Dr. Martin Schechter, NAOMI's principal investigator, said at a news conference held to announce the findings. "Our results show it to be very effective."

    The study is the latest effort made by a city with a history of employing often counterintuitive methods of tackling its drug problem. But while advocates tout the study's results, critics say the efforts amount to nothing more than a band-aid solution and a dangerous step toward legalizing drugs.

    Fluctuating levels of local and federal support could either undergird or derail the effort here, and, with heroin demand increasing worldwide, it's a debate other nations are monitoring.

    How does the treatment work?

    HAT targets chronic addicts who have repeatedly tried but failed to kick the addiction that consumes their lives and devours taxpayer dollars through hospital trips and policing costs.

    Instead, they are given controlled doses of heroin in a supervised clinic.

    Researchers believed it would allow addicts to reduce their overall drug use, participate in less crime, and stay in treatment longer.

    "This is a group, frankly, that society has written off as being beyond help," says Dr. Schechter, the director of the University of British Columbia's School of Population and Public Health.

    Vincent, the drug user, says that he tried to quit heroin seven or eight times before entering the NAOMI study.

    But he was always pulled back by the persistent cravings that left him ill.

    "It's not something that I would wish on anybody," says Vincent.

    With doses of heroin given three times a day at the clinic, Vincent stopped spending his days and nights trawling for his next hit.

    For the first time in years, he found part-time work, unloading shipping containers down at the city's port.

    "I was actually able to live a normal life," says Vincent.

    A majority of participants had comparable results, NAOMI researchers found.

    After 12 months in the study, illicit heroin use fell by almost 70 percent.

    The number of days participants said they spent being involved in "illegal activity" was halved, as was the reported amount of money spent on drugs.

    And 88 percent of those treated with heroin remained in treatment for at least one year.

    In a climate where the thought of prescribing heroin to addicts might make the federal government queasy, proponents still see offering the drug in a range of treatment programs as a realistic option.

    "Many people believe that we need a different approach," says Vancouver Mayor Sam Sullivan, who wants to see a clinic set up "tomorrow."

    Vancouver is home to a concentrated and very visible addiction problem that has shamed and confounded successive governments.

    One local advocacy group estimates there are 5,000 injection drug users living in the 12-block neighborhood locals used to call skid row: the Downtown Eastside.

    And with Vancouver set to become a specimen under the international microscope of the 2010 Winter Olympics, there is an added urgency to address the problem.

    "I think that once the citizens realize how much crime is going down, how much the load on our health services is going down, how much cheaper it is for everyone, that there's going to be a demand for this kind of program," Mr. Sullivan says.

    Critics Decry Slippery Slope

    Yet others see the study's results as another wobbly step in the wrong direction.

    "Giving drugs as a method of treatment is a bunch of nonsense," says Al Arsenault, a 27-year veteran of the Vancouver Police Department, now retired.

    "These guys just don't get it. Drug addicts need the cure, not the poison."

    Mr. Arsenault said he agrees with addiction specialists that a small group of addicts will not quit drugs. But he argues the focus should instead be on increasing treatment options for all drug users, not prescribing drugs to the chronic abusers.

    "What they're doing is they want to legalize drugs, when there's not enough treatment centers available," Arsenault says. "That's totally backwards.

    "You don't start there, substituting one drug for another to keep them chemically addled in the corner," he says.

    But the study's researchers remain confident in their findings.

    "Based on the evidence," says Schechter, "we could apply and we will apply to have heroin licensed."

    Author: Irwin Loy, Contributor to The Christian Science Monitor
    Cited: The North American Opiate Medication Initiative
    Pubdate: Thu, 30 Oct 2008
    Source: Christian Science Monitor (US)
    Copyright: 2008 The Christian Science Publishing Society

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  1. chillinwill
    The Firestorm Over Giving Diehards A Free Heroin Fix

    VANCOUVER -- Long-time addict Robert Vincent says he's living proof that getting free, daily heroin can improve the quality of a drug user's life, possibly steering him closer to recovery. "I wasn't waking up in the middle of the night worrying where I was going to get the money to get my fix," said Mr. Vincent, who speaks with a slight lisp, the result of large gaps between his teeth. "I started to eat better, regain my appetite."

    [imgl="white"][/imgl]Mr. Vincent, 36, was one of 115 men and women, all diehard heroin addicts, who were part of a groundbreaking but controversial Canadian medical trial, called NAOMI - the North American Opiate Medication Initiative - which doled out free heroin for a year to addicts in Vancouver and Montreal. Others in the study received methadone or hydromorphone, a prescription painkiller.

    Its preliminary results were released last month, with researchers concluding that most addicts committed fewer crimes and took better care of themselves when they didn't have to steal and panhandle to support their pricey heroin habits. They say they will use the results to press the government to consider free heroin as a treatment option for incurable addicts.

    Mr. Vincent, they say, is an example of how an addict's life can improve when freed from the constraints of scrounging for money to feed a costly, illegal habit. While on the study, Mr. Vincent left the street, found an apartment, landed a job and gained 30 pounds.

    But then the free heroin stopped.

    Today, he is back living on the street, delving through back-alley garbage bins for returnable bottles to earn money to buy drugs. He said he uses street-purchased morphine and hydromorphone. The day after an initial interview with The Globe and Mail, Mr. Vincent failed to show up for a follow-up meeting. He was spotted a few hours later standing outside Vancouver's supervised injection site, his eyes fluttering and his chin drooped on his chest. He was clearly high.

    According to NAOMI researchers, addicts like Mr. Vincent fare better when they can obtain drugs for free in a supervised medical setting.

    But do they?

    Some addiction physicians say it is unethical to provide free heroin to severely addicted, long-term injection-drug users. They also say the NAOMI results, which were based on the addicts' answers to questions, may have been skewed to support a case for free heroin.

    "There is a fine line between harm reduction and enabling," said Stanley deVlaming, who has treated addicts in Vancouver's Downtown Eastside for years. Dr. deVlaming believes the study, which he says was based largely on self-reporting, was politicized. Severely addicted people knew that if they responded positively to the free heroin, it could bolster the chances of receiving the illegal drug down the road.

    Dr. deVlaming argues that the best way to treat heroin addiction is with methadone, a synthetic drug that helps prevent withdrawal sickness but does not induce euphoria.

    "For many of these patients, if I hand them their heroin, if I make it easier for them to stay addicted, am I doing them any favours?" Dr. deVlaming asked. "When I treat a patient, I often say that I am treating two sides of that person. There's one side that's trying to get better and there's that side of them, the addicted side, that wants to stay addicted. I try to align myself with the side of them that wants to get better."

    Another Vancouver addiction physician, Milan Khara, said doctors who speak against the effectiveness of the heroin trials have been harassed, as have those who have criticized another so-called harm-reduction initiative, Vancouver's supervised injection site.

    Dr. Khara criticized the NAOMI results, saying he too thinks the participants in the heroin study were motivated to report positive results.

    "At the end of the day, these individuals have an addiction," he said. "If they believe their answers are going to lead to a lifetime of free heroin, their answers become highly unreliable."

    Dr. deVlaming says he has concerns too with any treatment that involves daily injections, which often cause serious infections in the heart, spine or bones. "There is nothing safe about repeated daily injections directly into your veins," he said.

    The heroin trials involved 251 people. In addition to the heroin participants, 111 received methadone orally and 25 were injected with hydromorphone.

    Greg Liang, an addict who was part of the heroin trial, says the program helped stabilize his life. Mr. Liang felt tremendous relief at not having to hustle for money to buy drugs. The NAOMI heroin was pure and uncut, providing a longer high than street heroin. "It was quite delicious," he said in an interview at a Vancouver coffee shop.

    But Mr. Liang, 41, who began using drugs at 18, says the free heroin made him complacent about his addiction. Other addicts, he says, took advantage of the free heroin, even competing for how much they could consume each day. For some, their habits grew worse. "They were heroin pigs," he said, shaking his head.

    After nine months on the heroin trial, Mr. Liang says, he switched to methadone because he knew it would be hard to stop cold turkey when the study ended.

    Today, Mr. Liang is still using heroin and cocaine. He says he's not sure if the heroin program helped his addiction. Like Mr. Vincent, his quality of life improved for a period. He began volunteering for the city of Vancouver, helping addicts. It eventually became a paid, part-time position.

    But Mr. Liang says his life is still controlled by drugs. A stressful day can set off a binge. He thinks the only way to quit drugs is to move far from Vancouver's Downtown Eastside, where there are scores of services for addicts.

    "Everything is provided for you here. There's always a meal, always a place to sleep, cheap housing," he said.

    But researchers on the NAOMI project have said the study bolsters the argument for legalizing heroin in some controlled settings as a method of treating hardcore addicts.

    The research project, which operated from a clinic in Vancouver's Downtown Eastside, still treats a handful of patients who stayed on the methadone plan.

    The team appealed to Vancouver's health-funding authority to keep the clinic open, providing methadone and hydromorphone. But the group hasn't heard a response.

    Martin Schechter, NAOMI's chief investigator, said researchers have no qualms about giving addicts free heroin and denied the program helped enable their addictions.

    "This is a way of providing a maintenance therapy that allows them to get out of the street cycle of illicit drugs because these people are injecting heroin right now," Dr. Schechter said. "It's not like we're starting them on heroin. They're on it now. So the question is: Who do you want prescribing it? You have the black market or doctors or nurses."

    Author: Jane Armstrong
    Pubdate: Tue, 04 Nov 2008
    Source: Globe and Mail (Canada)
    Copyright: 2008 The Globe and Mail Company
  2. adzket
    swim heard the uk where trying this a number of yrs back but not heard anything on this since any swiys know what the score is?
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