On the Prescription of Medical Heroin

I am so impressed by Vancouver’s open minded drug reform efforts. They continue to experiment with controversial treatments, but I always feel as though they have the addicts best interests in mind. I recently read the book “In the Realm of Hungry Ghosts” by one of the main influencers of the Supervised Injection Sites in Vancouver, Dr. Gabor Mate. It was written with such love and though he admits that he constantly has to remind himself to be totally accepting of the addicts he works with, at least he proactively tries. That’s more than 99% of the population could say.

“In 2007, a study was underway in Vancouver and Montreal that registered 251 heroin addicts that had tried but were unable to kick the habit using the standard methadone maintenance therapy. Methadone is, itself, an opiate not dissimilar to heroin, but taken orally, it reduces heroin withdrawals and prevents the rush some get from heroin, should a relapse occur. However, it is not a particularly effective drug as it does little to help addicts actually deal with the behavioural, emotional or cognitive components that accompany dependence or abuse of their drug of choice. So, the North American Opiate Medication Initiative (NAOMI) was launched, and methadone maintenance was compared to heroin (technically known as diacetylmorphine). As it turned, out, the results were not surprising; those receiving heroin spent less money on illegal drugs, committed less crime, enjoyed more greatly improved relationships with family and friends and also had improved medical, psychiatric and employment outcomes than those receiving methadone. The reason this is not surprising was that this study was based on a number of other studies conducted in Europe, particularly in Switzerland and The Netherlands, in which similar improvements were noted.

Following this data, researchers in Vancouver launched the Study to Assess Longer-Term Opioid Medication Effectiveness (SALOME) in which heroin would be compared to hydromorphone, which, like heroin, is a semi-synthetic opioid derived from morphine. Hydromorphone, however, is actually more potent than heroin, which, while problematic on the street if it is confused for heroin, could actually make it a useful medication for doctors trying to treat heroin users, leading to harm reduction and, ultimately, to abstinence from opiate use altogether. In the SALOME trial, 202 users were given either heroin or hydromorphone and assessed for similar outcomes as in the NAOMI trial described above, and as of November last year, 75 participants had finished their 12-month treatment plan and were released from the study. As the study is still ongoing, data are incomplete so results will be forthcoming in the near futrue.” Click the link below to read the entire article. . .

On the Prescription of Medical Heroin

 

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