Wednesday, 25 February 2009

Heroin Assisted Treatment in a Pill

Although heroin assisted treatment (HAT) and the many heroin trials have all been very successful, it is still not the perfect solution. Having to visit a clinic 2-3 times a day and the problems associated with injecting are the 2 main obstacles for patients. Some smart cookie in Canada though has come up with a fantastic idea that might go a long way to treating hard core addicts without these obstacles. Heroin in a pill.

The idea of providing morphine, heroin or hydromorphone to hard core addicts is not new and when put into practice has had great success. Sadly though, through blind ignorance, selling the proposal that drug addicts are given addictive drugs legally to inject has not been easy with the media often whipping up a storm of drug hysteria and governments scared of a public backlash. Supplying the drugs via a pill may be the answer. Fear of take away supplies being diverted to the black market would still be a major concern for many so there would need to be a strict monitoring system in place. It is achievable though with a well thought out system. Diversion though, in the real world becomes less of an issue when this simple question is asked:

Why would patients sell their high quality, legal heroin? ... to buy low quality street heroin?

Methadone may be the default treatment but it certainly has it’s problems. As someone who has been on methadone, buprenorphine and Slow Release Oral Morphine (SROM) to treat my heroin addiction, I can testify to the superiority of a morphine pill. Methadone often leaves the patient ‘flat’ which usually doesn’t happen when given drugs like Morphine. For those who don’t respond to methadone, detox. or rehab, having more options can only be beneficial. Once we start getting serious about treating addiction without the accrued bias from years of misinformation, morphine, heroin or hydromorphone in a pill becomes attractive. With strict guidelines, therapy/counselling and close monitoring, we might finally begin to help those long term users who don’t respond to current treatments and continue to use street drugs.

Can Pill Replace Heroin For Addicts?
Febuary 2009
Video report from CTV British Columbia's Maria Weisgarber

Researchers behind a controversial approach to Vancouver's drug problem are trying to launch a new study.

Hundreds of people took part in the NAOMI project, which stands for North American Opiate Medication Initiative. The project provided drug addicts with heroin, methadone and a pain medication called Dilaudid.

Rob Vincent took part in NAOMI. He says his health improved and he was able to work.

"I didn't have to worry about waking up in the morning and worry about where I'm going to come up with the money to get better now," he said.

Now there's a proposal for a similar study, called SALOME (Study to Assist Longer Term Opiod Medication Effectiveness) which would eventually test whether injectable drugs could be replaced with a pill.

"If you could get some people onto oral medication they could be treated much more simply," said Dr. Martin Schechter, a former NAOMI researcher.

The province has called NAOMI's results promising -- but says it's waiting for peer-reviewed published findings. Meanwhile, research advocates hope Tuesday's budget will include money for an international research treatment centre in BC.

"We have world class leading expertise here in Vancouver today," says Trish Walsh with the Inner Change Foundation. "We're just not giving them the tools to do the job."

The NAOMI project ended up finding pain medication worked just as well as heroin. But Dr. Schechter says when the three year study ended, so did the benefits for many of the participants.

"What we've learned is some of the people...a significant proportion of the people that were doing well subsequently relapsed in the first six months," he said.

Rob Vincent relapsed more than once.

"If you're going to make a project such as that where you're going to get everybody's hopes least make it so it's continuous, and if you are going to have a cut-off date, have some sort of back-up, so that they're not just being thrown out back onto the street," he said.

The new project being proposed is another three year study.


Toaf said...

Very interesting stuff, mate.

Terry Wright said...

Thanks Toaf.

If you visit the link and watch the video clip, an Insite worker says "After decades of searching for solutions in the downtown eastside why would we turn our back on something that finally works?"

Good question.

Heroinhead said...

Well i agree it can only help to have more options on the market. Though when we talk of treating heroin addiction don't forget it is much different treating an injecting user than a smoker or snorter. There is also the needle fixation and the actual fix... which pills do not give (no matter what they are). You can get onto injectable drug programs in england (though very difficult). Of course, they are extremely controversial but being an intravenous user myself it is what would stop me buying on the street. This is only a halfway mesure because whether I am shooting prescribed heroin or street heroin I am still shooting and this is what is unacceptable socially.

Take care


Terry Wright said...

Thanks HH.

At least with prescription heroin, you have access to clean gear, quality heroin, medical staff near by, sanctuary from prosecution and access to rehabilitation. A much better option than the alternatives.

BTW, I am finally getting over my needle fixation. I never thought it could happen but it is.

Take care.