Pubdate: Tue, 21 Oct 2008
Source: Concordian, The (CN QU Edu)
Copyright: 2008 The Concordian
Contact:  http://www.theconcordian.com/
Details: http://www.mapinc.org/media/3153
Author: Katherine Scott
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?131 (Heroin Maintenance)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Bookmark: http://www.mapinc.org/topic/NAOMI (North American Opiate 
Medication Initiative)

COMING TO A PHARMACY NEAR YOU

Synthetic Heroin Prescribed To Users, Who Can't Tell The Difference

Injection drug users cannot distinguish between heroin and a legal 
substitute, according to a Canadian clinical study released on Friday.

The North American Opiate Medication Initiative (NAOMI) study tested 
the effect of prescribing opiates to addicts in Vancouver and 
Montreal. Though the study was not specifically designed to test the 
legal opiate hydromorphone as a treatment for addiction, study 
representative Julie Schneiderman said they had enough clinical 
evidence to begin prescribing the drug. While no proposal has yet 
been put forward, Schneiderman said study organizers had begun 
looking for funding to open a clinic.

"Hydromorphone is a legal drug in Canada," said Schneiderman. "And 
off-label use doesn't require federal approval." Because the drug is 
not currently approved for addiction treatment, this usage is 
referred to as "off-label." However doctors are allowed to prescribe 
drugs using their own judgment, including for "off-label" uses.

Dr. Dan Small, president of the Portland Hotel Society, which helps 
run a safe injection facility in Vancouver, disagrees with the 
study's findings. "That part of the treatment arm, Dilaudid 
(hydromorphone), is 26 people. You cannot draw scientific conclusions 
from 26 people. What that means is you need to go and do further 
research and that's where they are going to end up. We are going back 
to where we started again."

Dr. Small added, "there is a college of physicians which in no way is 
going to let [doctors] use Dilaudid to treat addiction. It's not 
going to happen. If a doctor were to do that they would be taken out 
of practice."

The NAOMI had an unethical side to it," said Dr. Small. "After 15 
months they cut everybody off of heroin, and what happened to those 
people? They resumed illicit drug use, they resumed the terrible 
things people have to do to get drugs, like the survival sex trade."

This is the first study of its kind in North America, but the NAOMI 
results contribute to a pre-existing body of international research 
supporting prescribed heroin as a treatment for severe opiate 
addiction. Switzerland, The Netherlands, Germany, and Spain have all 
run studies similar to NAOMI and heroin maintenance has been used to 
treat addicts in the United Kingdom since 1926.

Because hydromorphone is legal, a clinic using this drug would not 
have to rely on an exemption to federal drug laws, like the one that 
allows Vancouver's Insite, the only safe injection site in North 
America, to function. Proponents hope this will help them get around 
the Federal government's opposition to programs like Insite, which 
the government has challenged in court.

Only the most severely addicted, who had not benefited from 
conventional addiction treatments, such as detox and methadone 
programs, were accepted into the study. Vancouver and Montreal have 
the largest proportion of Canada's 60,000-90,000 heroin addicts.

The clinical trial exists through a temporary exemption from Canada's 
drug laws. The Canadian Institutes of Health Research has funded the 
$8.1 million project, one of the largest grants ever awarded by the institute.
- ---
MAP posted-by: Jay Bergstrom