Advancing Care: SALOME

Study participants Max (left) and Lynda at April 2016’s news conference. Since the results of the SALOME study were released, Health Canada has moved to allow doctors to apply for special access to prescribe pharmaceutical heroin to severe addicts.

On April 6, 2016, researchers from Providence, the Centre for Health Evaluation and Outcome Sciences (CHÉOS) and UBC’s School of Population and Public Health announced the results of the ground-breaking SALOME research; the only clinical trial of its kind in the world.

The Study to Assess Longer-term Opioid Medication Effectiveness, or SALOME, found hydromorphone (HDM) to be as effective as diacetylmorphine (pharmaceutical-grade prescription heroin) for people who have not benefited from previous treatments, such as methadone or suboxone.

In short, the treatment of chronic heroin addiction now has another licensed, accessible, stigma-free option in its toolbox: hydromorphone.

“When I entered the program, I was homeless, committing crime to get a fix and weighed about 140lbs. I had really bottomed out,” explained the now-210lb Max, a SALOME study participant. “This gave me the chance to get out of something I couldn’t climb out of. I’m not sure if I’d be here today if it hadn’t been for this opportunity. It has completely changed my life.”

Prior to SALOME, hydromorphone had never been evaluated as a substitution treatment for opioid dependence, which is where the work of SALOME Principal Investigator, Dr. Eugenia Oviedo Joekes, and Dr. Scott MacDonald, lead physician at Providence’s Crosstown Clinic (where the study was conducted), comes in.

“Hydromorphone is a widely available licensed pain medication. Our study shows that hydromorphone is as effective as diacetylmorphine, providing a licensed alternative to treat severe opioid use disorder,” said Dr. Oviedo-Joekes. “Providing injectable opioids in specialized clinics under supervision ensures the safety of both the patients and the community, and the provision of comprehensive care.”

In addition to its findings, the study’s model of care was key in its success, and in the future delivery of heroin treatment.

“It’s not like they gave us the narcotic and then sent us out the door,” says Max of his experience with the staff team at Crosstown Clinic. “They helped us get our teeth checked, keep appointments, get IDs, bank accounts, a place to live. They helped us rebuild our lives.”

Emphasizing that it’s not about a drug, but rather bringing humanity back to addictions treatment, Providence’s director of Urban Health & HIV/AIDS, Scott Harrison describes a supervised injection site like Crosstown as a sanctuary for those who are profoundly addicted.

“Rather than people seeking treatment and being met with discrimination, this model provides compassion, care, and a reason to have hope.”

While the results of the study have already yielded international attention on the future of heroin treatment, on an organizational level the study also serves as a reminder of the populations we have a heart for, and why we do the work we do.

“We are trying to provide alternative treatments for people who are continuing to inject in the street, and we are not serving them well with the few options we have,” concludes Dr. Oviedo-Joekes. “This study, and the pursuit of more treatment options, is a statement to who we are as a community: if a treatment isn’t working, what are we going to do to help the people who need it the most?”

Find out more ways that Providence is advancing care in the areas of urban health, HIV and mental health

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