For many hardcore heroin addicts, the hustling begins first thing in the morning. They wake up with one thing in mind: How to get their next fix. Some turn to panhandling, prostitution or crime to come up with the cash for drugs. But a heroin study seems to have changed that for some Montreal addicts.
Prescribed Heroin Project 'Promising' Brett Bundale The Gazette June 2008
North America's first research study on medically prescribed heroin will wrap up in a few weeks. The goal of the North American Opiate Medication Initiative, funded by the Canadian Institute of Health Research, is to examine harm reduction and the treatment of illicit drug use.
The $8-million clinical trial started in 2005 in Montreal and Vancouver, the site of Insite, North America's only safe-injection site.
As the project winds down, Quebec is considering setting up a safe-injection facility in Montreal, Health Minister Philippe Couillard said Wednesday.
But unlike a safe-injection site, where addicts inject themselves with their own street drugs under the supervision of a nurse, the research study uses medically prescribed pharmaceutical-grade narcotics.
Although the findings will not be published until the fall, the preliminary results are promising, said Suzanne Brissette, one of the study's doctors and the lead investigator in Montreal.
"The cost effectiveness will be an important part of our findings," Brissette said.
In addition to the human costs, an untreated heroin addict costs Canada an estimated $45,000 a year in public health care, criminal justice and welfare.
Similar studies in Europe suggest prescribed heroin programs can save the public nearly $20,000 a year per addict, after research and clinical costs are factored in.
The North American study offered addicts information about how to avoid some of the risks of drug use, like using shared or unsterilized needles, and how to manage - if not kick - the habit.
Heroin users are at risk of developing abscesses, contracting such diseases as HIV/AIDS and hepatitis C, and other problems related to adulterated heroin sold on the street.
In Montreal, addicts were allowed to come to the clinic three times a day to get their fix.
"What was surprising was that, as their lives gained stability, many came only twice a day," Brissette said.
In addition, the maximum heroin dose allowed was about 400 milligrams, but on average addicts chose to take only 170 milligrams at a time.
"Because the heroin was free, people thought an escalation in use would occur. But this didn't happen," Brissette said.
The study followed a strict recruitment process.
"There was a fear we'd attract more users by giving out free heroin," Brissette said.
"The participants had to have repeatedly failed the standard treatment," Brissette said, which involves oral methadone, a drug similar to morphine, as a substitute for heroin.
Once selected, nearly half the participants underwent the standard methadone treatment. The other 55 per cent received either heroin or another opiate that is injected, hydromorphone.
Many users put on weight and some managed to find jobs, Brissette said.