Pubdate: Wed, 03 May 2006
Source: Vancouver Courier (CN BC)
Copyright: 2006 Vancouver Courier
Contact:  http://www.vancourier.com/
Details: http://www.mapinc.org/media/474
Author: Allen Garr
Cited: North American Opiate Medication Initiative http://www.naomistudy.ca
Cited: 17th International Conference on the Reduction of Drug Related 
Harm http://www.harmreduction2006.ca
Bookmark: http://www.mapinc.org/find?131 (Heroin Maintenance)
Bookmark: http://www.mapinc.org/find?132 (Heroin Overdose)
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

NAOMI'S END WILL JUNK LIVES

Dianne Tobin has been a heroin addict for 30 years and on Sunday she 
got to tell her story at the 17th annual International Conference on 
the Reduction of Drug Related Harm.

What captured the audience's attention was not so much the misery the 
54-year-old Tobin faced as a petty thief and prostitute. It was about 
her past four months on heroin maintenance. It has turned her life around.

If that was the end of the story, it would be heartwarming. But there 
is a complication that could drive Tobin and 100 more like her back 
on to the street.

Tobin is part of the NAOMI project, the North American Opiate 
Medication Initiative. It is being carried out in Vancouver and 
Montreal. The first recruits signed on just over a year ago. At its 
centre is an ethical dilemma being much debated but unlikely to be 
resolved in time to help the likes of Tobin.

A couple of times a day for the past four months, Tobin has checked 
into a clinic set up for the project and injected herself with pure 
heroin. The heroin was produced in a government-supervised lab. 
Before it could be distributed, the people doing the study needed 
permission from Health Canada.

The NAOMI project is the poster child of this international 
conference. The lead scientist running the project is the highly 
respected Dr. Martin Schechter. In his keynote address to the 
conference on Sunday night he pointed out, while NAOMI is radical in 
this part of the world, heroin maintenance trials have been going on 
elsewhere for some time. The Swiss began their program in 1996. There 
have also been similar studies in Germany and the Netherlands.

To qualify for the program, participants had to have a proven record 
of two failures in methadone treatment, the standard drug treatment 
substitute for heroin. Of those selected, 45 per cent get methadone, 
45 per cent get heroin and 10 per cent shoot up an opiate called Dilaudid.

Now here's the catch and the ethical dilemma. No matter how well they 
do on heroin, after 12 months the injections are reduced. After 15 
months it is zero. In fact the first people who signed on are in 
their final few weeks before they get cut off, which makes the 
ethical debate even more pointed.

NAOMI spokeswoman Julie Schneiderman says to continue beyond the 15 
months would be illegal.

But if the drug being tested was for breast cancer, for example, and 
it was proving effective, under standard ethical medical protocols 
all people involved in the study would be given the new drug. The 
scientists would work at getting it approved for general use.

The three similar studies in Europe have shown that heroin 
maintenance is effective and beneficial; the subjects' social, 
economic and physical health improved and drug-related crime 
declined. The Netherlands study concluded that when addicts were cut 
off there was rapid deterioration in the lives of 82 per cent of 
participants. Nonetheless, NAOMI participants will likely be offered 
methadone, a treatment that had to fail them in order for them to 
qualify for NAOMI.

NAOMI comes under attack for those reasons in a paper co-authored by 
UBC research associate Dan Small. It's about to be published in the 
international Harm Reduction Journal. Small works at the Portland 
Hotel. Some of his clients are in NAOMI. He expects the worst.

Medical ethicist Dr. Tim Christie, with the B.C. Centre for 
Excellence in HIV-AIDS, agrees with Small. He says if NAOMI adhered 
to the usual ethics of research, the subjects would continue to get heroin.

And that's the point. This is about heroin and junkies, not our 
sisters or mothers and breast cancer. Christie says NAOMI "is a study 
to prove the obvious without a doubt."

It is about politics, not science or ethics for that matter. 
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MAP posted-by: Richard Lake