Though a lot of heroin addicts are able to kick the habit
through a methadone program, about 10-20% end up relapsing.
So what to do with these essentially unfixable users?
A controversial theory says the way forward is to stabilize
rather than try to cure them by prescribing controlled
doses of heroin. Last month Canada took a bold step and
set out to test that theory.
On February 10, enrolment began
in Vancouver for the North American Opiate Medication
Initiative (NAOMI), this continent's first clinical
trial of prescribed heroin for chronic addicts. Funded
by an $8.1 million grant from the Canadian Institutes
of Health Research (CIHR), NAOMI will enrol 470 participants
at three sites in Vancouver, Toronto and Montreal.
EUROPEAN
MODEL
The study takes its cue from prescribed heroin projects
in Switzerland and the Netherlands, which indicated
promising results for helping chronic users stabilize
their addiction, reduce criminal activity and lead more
productive, healthy lives. NAOMI has an added aim, explains
study co-investigator Dr David Marsh, clinical associate
professor in healthcare and epidemiology at the University
of British Columbia and Physician Leader of Addiction
Medicine for the Vancouver Coastal Health Authority.
Unlike the Swiss and Dutch studies, NAOMI will compare
the method to optimized methadone maintenance treatment
— and will be the first study to do so.
"This trial will tell us if heroin
prescription really is a viable and effective option
for Canada, or whether we ought to look at improving
the quality and availability of our methadone maintenance
treatment system," says Dr Marsh, adding that the heroin
being dispensed will be pharma-grade, sterile and of
a known dose, unlike what users get on the streets.
SEASONED
USERS ONLY
In order to qualify for the trial, participants must
be 25 or older, have been addicted to the drug for at
least five years, including the past 12 months, and
have unsuccessfully tried a methadone program at least
twice before.
Dr Marsh explains that there are
many reasons methadone treatment may not work for some
people, including genetic, social, and motivational
problems. "It's common in healthcare that we need multiple
treatments for a single condition because one treatment
doesn't work for everybody," he says.
Participants in the heroin half
of the trial will come to the clinic three times a day
for their injection. The heroin will stay on-site, where
participants of both trials will have access to counsellors,
social workers and other types of interventions. Participants
will remain in the study for 12 months, after which
they will be transitioned to methadone or other treatment
programs.
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