PRESCRIBED HEROIN PROJECT 'PROMISING'

Gave Free Pharma-Grade Drugs. Quebec Health Minister Considering
Opening Safe-Injection Site In Montreal

For many hardcore heroin addicts, the hustling begins first thing in
the morning. They wake up with one thing in mind: How to get their
next fix.

Some turn to panhandling, prostitution or crime to come up with the
cash for drugs.

But a heroin study seems to have changed that for some Montreal
addicts.

North America's first research study on medically prescribed heroin
will wrap up in a few weeks. The goal of the North American Opiate
Medication Initiative, funded by the Canadian Institute of Health
Research, is to examine harm reduction and the treatment of illicit
drug use.

The $8-million clinical trial started in 2005 in Montreal and
Vancouver, the site of Insite, North America's only safe-injection
site.

As the project winds down, Quebec is considering setting up a
safe-injection facility in Montreal, Health Minister Philippe
Couillard said Wednesday.

But unlike a safe-injection site, where addicts inject themselves with
their own street drugs under the supervision of a nurse, the research
study uses medically prescribed pharmaceutical-grade narcotics.

Although the findings will not be published until the fall, the
preliminary results are promising, said Suzanne Brissette, one of the
study's doctors and the lead investigator in Montreal.

"The cost effectiveness will be an important part of our findings,"
Brissette said.

In addition to the human costs, an untreated heroin addict costs
Canada an estimated $45,000 a year in public health care, criminal
justice and welfare.

Similar studies in Europe suggest prescribed heroin programs can save
the public nearly $20,000 a year per addict, after research and
clinical costs are factored in.

The North American study offered addicts information about how to
avoid some of the risks of drug use, like using shared or unsterilized
needles, and how to manage - if not kick - the habit.

Heroin users are at risk of developing abscesses, contracting such
diseases as HIV/AIDS and hepatitis C, and other problems related to
adulterated heroin sold on the street.

In Montreal, addicts were allowed to come to the clinic three times a
day to get their fix.

"What was surprising was that, as their lives gained stability, many
came only twice a day," Brissette said.

In addition, the maximum heroin dose allowed was about 400 milligrams,
but on average addicts chose to take only 170 milligrams at a time.

"Because the heroin was free, people thought an escalation in use
would occur. But this didn't happen," Brissette said.

The study followed a strict recruitment process.

"There was a fear we'd attract more users by giving out free heroin,"
Brissette said.

"The participants had to have repeatedly failed the standard
treatment," Brissette said, which involves oral methadone, a drug
similar to morphine, as a substitute for heroin.

Once selected, nearly half the participants underwent the standard
methadone treatment. The other 55 per cent received either heroin or
another opiate that is injected, hydromorphone.

Many users put on weight and some managed to find jobs, Brissette
said.

"Instead of worrying about their next fix, they had time to worry
about far more important issues like their health and finding a job or
an apartment," Brissette said.

Although the study has a team of doctors, nurses and social workers to
counsel participants about their options once the study ends, the
future for the most serious addicts is grim.

"For some, a year of prescribed heroin treatment is enough, and they
may successfully move on to a more standard form of treatment and
possibly even abstinence. But others need more time," Brissette said.

"As researchers, it's difficult, but it's no longer in our hands."
Federal Health Minister Tony Clement said he would consider the idea
of a safe-injection site in Quebec, though his government is appealing
a B.C. court decision allowing Insite to continue work in the Downtown
Eastside.