Pubdate: Mon, 08 Nov 2004 Source: Vancouver Courier (CN BC) Copyright: 2004 Vancouver Courier Contact: http://www.vancourier.com/ Details: http://www.mapinc.org/media/474 Author: Naoibh O'Connor, Staff writer Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Bookmark: http://www.mapinc.org/find?136 (Methadone) Bookmark: http://www.mapinc.org/rehab.htm (Treatment) FREE HEROIN AT END OF LONG, WINDING BUREAUCRATIC ROAD Eight years after researchers proposed free prescription heroin to treat addicts, the project is close to reality. Recruitment for the short-term scientific trial, known as the North American Opiate Medication Initiative (NAOMI), will start this month, with the first clients beginning treatment early in the new year. Endless hurdles have delayed the study's startup. Not only did a site have to be found that neighbours didn't object to, but several Health Canada conditions had to be met. Researchers are waiting for an exemption under the Narcotics Act to prescribe the drug. But the end is in sight, which comes as a relief to clinical lead Dr. David Marsh. Eight years ago, Marsh worked with the Addiction Research Foundation in Toronto. At a meeting with other researchers to discuss treatment options other than methadone, the idea for the heroin trial was born. "After all this time and effort it's exciting to get if off the ground," he said standing outside the study site at the corner of Abbott and Hastings streets Thursday. Renovations are almost finished on the property at 84 West Hastings, which in past incarnations housed the Revival Centre church and a bank. Surveillance cameras are fastened to the outside of the building. Stringent security is in place even though little heroin will be kept in the clinic. Researchers are mainly concerned potential candidates will not realize the study will involve a limited number of participants and will run for only two years. Marsh said expectations are high and some might be disappointed considering officials estimate 4,000 addicts live in the city. "It's a research study, not a permanent program," said Marsh, who is certified by the Canadian Society of Addiction Medicine. Only those living in a prescribed area in the Downtown Eastside are eligible for the NAOMI trial. The criteria for acceptance is rigid. Only 88 addicts will receive prescribed heroin, while 70 will get oral methadone. Patients will be assigned to one of the two arms of the trial at random. Addicts will participate for a year and then be transferred to the best available treatment they'll accept. After injecting, heroin patients will be observed for 30 minutes before being allowed to leave and will be asked if they need counselling. The study hopes to determine whether prescribed heroin is better than methadone for addicts who have failed at standard therapies, and whether pharmaceutical heroin improves the health and quality of life of injection drug users, reduces homelessness or reduces addicts' contact with the criminal justice system. "[The study] is important because dependence on injected opiates is a devastating health problem," Marsh said. "We need as many options as we can to prevent overdose deaths, the spread of HIV and other health problems associated with drug use." By study's end, researchers may simply discover good quality methadone works better and is cheaper for treatment. "Maybe it'll be a vehicle for advocating better quality methadone," Marsh said. The study, which is also being conducted in Montreal and Toronto, is expensive. The Canadian Institute of Health Research is providing an $8 million grant, while renovation and security measures at the study sites cost $2 million. Once researchers are ready to begin recruitment for the NAOMI trial, a phone number will be posted around the Downtown Eastside and at service agencies. Calls will only be taken at certain hours of the day. NAOMI trial spokesman Jim Boothroyd said not all participants will begin at the same time. The study will also follow up on participants who drop out. - --- MAP posted-by: Derek