British Columbia researchers have shown that chronic heroin addiction can be effectively treated with hydromorphone, a licensed pain medication.
In a study published in JAMA Psychiatry, scientists in the Faculty of Medicine and Providence Health Care found that hydromorphone, a widely available licensed pain medication, is as effective as pharmaceutical-grade prescription heroin for people who have not benefited from previous treatments, such as methadone or suboxone. That accounts for about 15 per cent to 25 per cent of the opioid-dependent population.
Eugenia Oviedo-Joekes
The study shows there is a “licensed alternative to treat severe opioid use disorder,” said Eugenia Oviedo-Joekes, an Associate Professor in the School of Population and Public Health and a Scientist with the Centre for Health Evaluation and Outcome Sciences. “Providing injectable opioids in specialized clinics under supervision ensures safety of both the patients and the community, and the provision of comprehensive care.”
A total of 202 participants in Vancouver were randomized in a six-month double blind study to receive either injectable hydromorphone or injectable, pharmaceutical-grade prescription heroin. The medication was administered at Providence Health Care’s Crosstown Clinic under the supervision of an interdisciplinary team of physicians, nurses, social workers and counselors.
The researchers “shine a new light on how we can help people with heroin addictions,” said B.C. Health Minister Terry Lake. “While methadone and suboxone are effective for many people with opioid addictions, there is a proportion of people who have not found success with these treatments. The … study shows there are alternative treatments that may be able to help those who don’t respond to methadone and suboxone. This is very exciting research and could go a long way in helping those who need it.”
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 per cent were retained in treatment at six months.
Hydromorphone and pharmaceutical-grade heroin 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.
Since prescription-grade heroin is not available in Canada and many other countries for political and/or regulatory reasons, “hydromorphone has a significant advantage as a legal, licensed pain medication,” said Patricia Daly, Vancouver Coastal Health’s Chief Medical Health officer and a Clinical Professor in the School of Population and Public Health. “While methadone and buprenorphine/naloxone are effective heroin addiction treatments for many people and should remain the first line responses, no single treatment is effective for all individuals. Every person with severe opioid use disorder left untreated is at high risk of serious illness and premature death.”
Heroin addiction affects 60,000 to 90,000 Canadians. The CMAJ (Canadian Medical Association Journal) estimates it costs taxpayers at least $45,000 per individual each year in terms of related medical, public health, policing, criminal justice and jail expenses, along with crimes against people and property.
The Study to Assess Longer-term Opioid Medication Effectiveness (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 pharmaceutical-grade heroin.
The $7.4 million study received funding from the Canadian Institutes of Health Research (CIHR) and private donors through the fundraising efforts of the InnerChange Foundation and the St. Paul’s Foundation. Providence Health Care funded clinical care for participants during the study.