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Synthetic Heroin Prescribed To Users, Who Can't Tell The Difference

Injection drug users cannot distinguish between heroin and a legal
substitute, according to a Canadian clinical study released on Friday.

The North American Opiate Medication Initiative (NAOMI) study tested
the effect of prescribing opiates to addicts in Vancouver and
Montreal. Though the study was not specifically designed to test the
legal opiate hydromorphone as a treatment for addiction, study
representative Julie Schneiderman said they had enough clinical
evidence to begin prescribing the drug. While no proposal has yet
been put forward, Schneiderman said study organizers had begun
looking for funding to open a clinic.

"Hydromorphone is a legal drug in Canada," said Schneiderman. "And
off-label use doesn't require federal approval." Because the drug is
not currently approved for addiction treatment, this usage is
referred to as "off-label." However doctors are allowed to prescribe
drugs using their own judgment, including for "off-label" uses.

Dr. Dan Small, president of the Portland Hotel Society, which helps
run a safe injection facility in Vancouver, disagrees with the
study's findings. "That part of the treatment arm, Dilaudid
(hydromorphone), is 26 people. You cannot draw scientific conclusions
from 26 people. What that means is you need to go and do further
research and that's where they are going to end up. We are going back
to where we started again."

Dr. Small added, "there is a college of physicians which in no way is
going to let [doctors] use Dilaudid to treat addiction. It's not
going to happen. If a doctor were to do that they would be taken out
of practice."

The NAOMI had an unethical side to it," said Dr. Small. "After 15
months they cut everybody off of heroin, and what happened to those
people? They resumed illicit drug use, they resumed the terrible
things people have to do to get drugs, like the survival sex trade."

This is the first study of its kind in North America, but the NAOMI
results contribute to a pre-existing body of international research
supporting prescribed heroin as a treatment for severe opiate
addiction. Switzerland, The Netherlands, Germany, and Spain have all
run studies similar to NAOMI and heroin maintenance has been used to
treat addicts in the United Kingdom since 1926.

Because hydromorphone is legal, a clinic using this drug would not
have to rely on an exemption to federal drug laws, like the one that
allows Vancouver's Insite, the only safe injection site in North
America, to function. Proponents hope this will help them get around
the Federal government's opposition to programs like Insite, which
the government has challenged in court.

Only the most severely addicted, who had not benefited from
conventional addiction treatments, such as detox and methadone
programs, were accepted into the study. Vancouver and Montreal have
the largest proportion of Canada's 60,000-90,000 heroin addicts.

The clinical trial exists through a temporary exemption from Canada's
drug laws. The Canadian Institutes of Health Research has funded the
$8.1 million project, one of the largest grants ever awarded by the institute.