Results of world’s first study on new treatment for heroin addiction

Apr 7, 2016 | News

At a news conference yesterday, April 6, 2016, researchers from Providence Health Care (PHC), the Centre for Health Evaluation and Outcome Sciences (CHÉOS) at St. Paul’s Hospital and the School of Population and Public Health of the University of British Columbia (UBC), announced the results of the ground-breaking SALOME research, which is the only clinical trial of its kind in the world.

Published in the Journal of the American Medical Association (JAMA) Psychiatry, SALOME, which stands for the Study to Assess Longer-term Opioid Medication Effectiveness, 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, this means that the treatment of chronic heroin addiction now has another option in its toolbox: hyrdomorphone, a licensed pain medication. Not only is this outcome exciting because it works, but also because hydromorphone is legal, accessible and there is no stigma attached to using it.

“Prior to SALOME, hydromorphone had never been evaluated as a substitution treatment for opioid dependence,” said SALOME Principal Investigator Dr. Eugenia Oviedo-Joekes. “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. Providing injectable opioids in specialized clinics under supervision ensures safety of both the patients and the community, and the provision of comprehensive care.”

SALOME Principal Investigator Dr. Eugenia Oviedo-Joekes presenting the findings of SALOME, a four-year study on the longer term effectiveness of opioid medication.

A total of 202 participants in Vancouver were randomized in a six-month double blind study to receive either injectable hydromorphone or injectable diacetylmorphine (DAM). The medication was administered at Crosstown under the supervision of an interdisciplinary team of physicians, nurses, social workers and counselors.

And it is with the help of this team and their comprehensive approach that supports Crosstown patients in not only curbing their addiction, but truly turning a corner.

“It’s not like they gave us the narcotic and then sent us out the door. They helped us rebuild our lives,” says Max, a SALOME study participant 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. I turned 50 yesterday and if you would have asked me 5, maybe 10 years ago, I would never have thought I would make it to this birthday. Being in this study has completely changed my life, and I am very grateful.”

Max, SALOME study participant, sitting beside a fellow study participant, Lynda, who credits her involvement in the study with being able to now hold down a part-time job, go out for lunch with friends, and confidently says that likes herself; accomplishments she couldn’t say 18 months ago.

The notion of this study being more than just about administering a drug was echoed by Scott Harrison, director, Urban Health & HIV/AIDS. “It isn’t about a drug; it’s about a model of care. It’s about bringing humanity back to addictions treatment. A supervised injection site creates a sanctuary for those who are profoundly addicted and, rather than people seeking treatment and being met with discrimination, this model provides compassion, care, and a reason to have hope.”

Scott Harrison, director, Urban Health & HIV/AIDS

In addition to the encompassing treatment and support that’s provided within Crosstown’s supervised injection approach, Dr. MacDonald says previous research shows that providing heroin as medication is cheaper for society than drug addiction. “A single drug-addicted person costs taxpayers at least $45,000 a year in petty crime, policing, courts, jail time and health care,” he says. “Administering either medical heroin or hydromorphone in at Crosstown costs about $27,000 a patient each year, mostly in staff wages.”

Dr. Scott MacDonald, lead physician, PHC’s Crosstown Clinic.

While the results of the study have already yielded international attention, on a Providence level, it also serves as a reminder of 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?”

Key findings of the research include:

  • Injectable hydromorphone is as effective as injectable diacetylmorphine for long-term street opioid users not currently benefitting from available treatments (estimated to be about 10 per cent of the opioid-dependent population not currently in treatment).
  • Study participants on both medications reported far fewer days of street-heroin and other opioid use at six months (three to five days per month), compared to almost daily illicit opioid use prior to being enrolled in the study.
  • Participants also reported a significant reduction in days of illegal activities (from an average of 14.1 days per month to less than four).
  • Almost 80% were retained in treatment at six months.
  • Hydromorphone and diacetylmorphine are both safe when taken in a clinical setting. Out of a total of 88,451 injections, there were 14 overdoses and 11 seizures, all successfully managed in the clinic. If these events had occurred in the street, the outcomes may have been fatal.

SALOME started in late 2011 and concluded in late 2015. It is the follow-up study to the North American Opiate Medication Initiative (NAOMI), North America’s first-ever clinical trial of diacetylmorphine/prescription heroin as an opioid agonist treatment medication.

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Immensely important work, thank you for keeping us informed of your progress.

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