Monday, 20 October 2008

Another Successful Heroin Trial - Canada

Finally, the results are in from the North American Opiate Medication Initiative (NAOMI) enquiry into prescription heroin. Ironically though, it’s a bit of a fizzer. It just told us what has already been proven over and over again ... that prescription heroin is a vastly superior treatment than all other current or proposed programs for heroin addiction.

Canada is just the latest country to produce evidence that prescription heroin is more effective than methadone or abstinence based programs. Switzerland, Germany, The Netherlands and Spain have all had heroin trials and documented their success. The UK is currently finishing off their own trial which is already indicating similar results. Belgium, Israel, Denmark and other countries have announced they will also be conducting their own trials or have indicated their interest in doing so.

All participants reduced their involvement in crime and their spending on drugs, and all participants had health improvements, but those in the injectable heroin or hydromorphone group saw the greatest improvements overall. 
-Jessica Werb. Health Straight Talk

Many countries will now be in that political quagmire that faced Australia back in the late 1990s. Is it worth risking political points and the inevitable attacks from the anti-everything brigade for implementing the safest and most successful treatment program to tackle heroin addiction? Luckily this time around, Australia won’t have John Howard to override the consensus of the states or fellow politicians but the Rudd government is yet to prove itself in providing an evidence based policy. There has been no clear direction yet from the government except the usual political posturing about being tough on drugs. Rudd did claim that he would support evidence based policies but drug policy doesn’t always follow the usual rules. Is this going to be too much of a stretch for a church going conservative? Are the likes of Drug Free Australia (DFA) and the twats from the MSM going to derail another attempt at treating a medical problem based on science and research?

Results show that North America’s first heroin therapy study keeps patients in treatment, improves their health and reduces illegal activity
North American Opiate Medication Initiative (NAOMI Study)

VANCOUVER, BC, October 17, 2008 – Researchers from the North American Opiate Medication Initiative (NAOMI Study) today released final data on the primary outcomes from the three-year randomized controlled clinical trial.

“Our data show remarkable retention rates and significant improvements in illicit heroin use, illegal activity and health for participants receiving injection assisted therapy, as well as those assigned to optimized methadone maintenance,” says Dr. Martin Schechter, NAOMI’s Principal Investigator, Centre for Health Evaluation and Outcome Sciences and Professor and Director, University of British Columbia School of Population and Public Health. “Prior to NAOMI, all of the study participants had not benefited from repeated standard addiction treatments. Society had basically written them off as impossible to treat.”

The data, which was collected from 251 participants at sites in Vancouver and Montreal, demonstrate that a combination of optimized methadone maintenance therapy (MMT) and heroin assisted treatment (HAT) can attract and retain the most difficult-to-reach and the hardest-to-treat individuals who have not been well served by the existing treatment system.

Key findings at the 12-month point of the treatment-phase of the study showed that HAT and MMT achieved high retention rates: 88 per cent and 54 per cent respectively. Illicit heroin use fell by almost 70 per cent. The proportion of participants involved in illegal activity fell by almost half from just over 70 per cent to approximately 36 per cent. Similarly, the number of days of illegal activity and the amount spent on drugs both decreased by almost half. In fact, participants once spending on average $1,500 per month on drugs reported spending between $300-$500 per month by the end of the treatment phase. Marked improvements were also seen in participants’ medical status with scores improving by 27 per cent.

Of particular note amongst the findings, participants receiving hydromorphone (DilaudidTM) instead of heroin on a double-blind basis (neither they nor the researchers knew) did not distinguish this drug from heroin. Moreover, hydromorphone – an opiate licensed for the relief of pain - appeared to be equally effective as heroin, although the study was not designed to test this conclusively. According to the NAOMI Study Investigators, further research could help to confirm these observations, allowing hydromorphone assisted therapy to be made more widely available.

While a comprehensive health economics study is pending, researchers have already determined that the cost of continued treatment is much less than that of relapse.

“We now have evidence to show that heroin-assisted therapy is a safe and effective treatment for people with chronic heroin addiction who have not benefited from previous treatments. A combination of optimal therapies – as delivered in the NAOMI clinics - can attract those most severely addicted to heroin, keep them in treatment and more importantly, help to improve their social and medical conditions,” explains Schechter.

A summary report of the findings and background information on the study are available at:
NAOMI trial finds heroin more effective than methadone
By Jessica Werb
Health Straight Talk

Heroin-assisted therapy is a safe and highly effective treatment for people with chronic heroin addiction, according to the final data released by the North American Opiate Medication Initiative (NAOMI) today.

The three-year randomized controlled clinical trial, lead by Dr. Martin Schechter of UBC’s School of Population and Public Health, included 251 participants at sites in Vancouver and Montreal. Forty-five percent were given oral methadone, 45 percent were given injectable heroin, and 10 percent were given injectable hydromorphone, an opiate licensed for pain relief.

Those treated with heroin had a retention rate of 88 percent, compared to 54 percent for participants who received optimized methadone maintenance therapy.

Sixty-seven percent of those treated with heroin responded to treatment, compared to 47.7 percent of those treated with methadone.

Illicit heroin use declined in all patients, but was declined most sharply among those treated with injectable heroin or hydromorphone.

All participants reduced their involvement in crime and their spending on drugs, and all participants had health improvements, but those in the injectable heroin or hydromorphone group saw the greatest improvements overall.

The study also found that participants receiving hydromorphone did not distinguish it from heroin, and that it appeared as effective in treatment as heroin. However, researchers noted that the study was not designed to test this conclusively.

Given their less-than-enthusiastic reaction to InSite, I wonder how Stephen Harper and the RCMP are going to react to these findings?


Tonia said...

Nicola Roxon on heroin trials:

In 2001-

"...nobody thinks that heroin trials are a fabulous idea, and it's [not] necessarily the cure for everything, but to bring out this idea that to even consider it is being soft on drugs I think is a real defeat and it's us saying that we can't address a complex issue which might have to have a number of ways of approaching it..."

In 2006-

"I don't think we should be talking about decriminalising heroin use, it is a big problem and it is criminal and we should penalise people. We should of course make sure that we have proper detox programs, that we can support people if they are jailed to kick their habits. All of those things are fine. But I don't think you can have at the core of it a message which says using heroin is ok. It is a deadly dangerous drug and I don't think we want a party in Australia arguing that it is actually a good thing".

Ambiguous much?

Terry Wright said...

Thanks Tonia

Great stuff.

The second statement was from an interview with Neil Mitchell on Melbourne's 3AW. Roxon and Victorian opposition leader, Robert Doyle were discussing the Greens over their preferences in the upcoming Victorian election. There was a lot of political hype that the Green's drug policy supposedly included legalising all drugs so Mitchell and Doyle were giving Roxon hell because labor were getting their preferences. Her comments weren't actually about prescription heroin but about Mitchell's reference to a previous interview with the Greens about heroin penalties.

Of course it was all bullshit and just a beatup from labor and the libs. They were completely wrong about the Greens drug policy. Not once have they ever recommended legalising all drugs.

Neil Mitchell as usual did what he does best and shows why no serious media outlet would ever touch him with a 44 ft barge poll. It became obvious why he is employed by those media-tainment hovels called the HeraldSun and 3AW. He took a snippet of an interview with the greens where he asked about punishment for heroin use. The Greens member brought up Harm Minimisation but Mitchell persisted with his inane questioning.

He was just asking ridiculous questions of Roxon looking for a headline. A serious journalist only had to Google the Greens to find out what their actual drug policy is. Funny enough, the Greens have the most sensible approach of all the political parties.

Hopefully Roxon will stay on track from her 2001 statement.

epicene said...

Considering Clinton's weak evasion "didn't inhale" perhaps we could have a stock standard question of pollies now that the generational divide is shifting - "have you ever smoked dope? If not, why not?Anyone who grew up in the 70/80s who didn't smoke dope would be someone with a serious psycholgical problem.
Reality is for people who can't handle drugs

Firesnake said...

Sadly, Roxon wasn't the best choice for progressive policy initiatives. Her legal background is excellent, which is one problem. Her ignorance about the drug using community is another.

And the history of Labor and The Coalition challenging each other on who's 'softest' on drugs is lengthy. Pressure to be hard on all "traffickers" pushed the Greens to change policy.

Howard did real damage to the prevailing views, but now with a focus on failed law enforcement - globally - things may change.

Great news Terry. It's nice to see Canada produce such results in the present drug policy/legal dance with Harper and Co. over Insite.

Evidence based policy said...

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