HEROIN SHOULD BE USED AS TREATMENT, EXPERT SAYS

VICTORIA - Even if groundbreaking research into a substitute
treatment for heroin is successful, heroin itself should be available
as a medical option for addicts, a top addictions researcher told The
Globe and Mail Tuesday.

"Like in any other medical condition, patients respond well to a
given treatment, but not all of them," Eugenia Oviedo-Joekes said in
a forum on The Globe's website.

Dr. Oviedo-Joekes is a principal investigator of the SALOME project,
which is recruiting heroin addicts for a medical trial that will
offer both heroin and a legal narcotic substitute to determine their
effectiveness as a harm-reduction treatment. While the long-term goal
is to help the addicts get off hard drugs, in the short term, the
plan is to get them away from the more dangerous aspects of heroin
addiction, such as committing crimes, sharing needles, and shooting
up in back alleys.

The Study to Assess Longer-term Opioid Medication Effectiveness, set
to open clinics in Montreal and Vancouver by the end of this year, is
building on a previous medical trial that found addicts were
healthier and committed fewer crimes when given heroin in a clinic.

Dr. Oviedo-Joekes said there is already ample evidence that heroin is
an effective medical treatment for addicts who have not responded to
traditional methadone treatment: "Methadone works very well, [but]
not for everyone. We need alternatives to avoid leaving behind anyone
that needs care."

Later, she said the SALOME trial will be the first to measure in
depth whether Hydromorphone, a legal narcotic available by
prescription in Canada under the name Dilaudid, can work as a
substitute treatment.

"Heroin-assisted treatment works; I cannot go against the evidence.
If Hydromorphone works as good as heroin, we can provide an
alternative until our society is ready to accept other approaches,
such as heroin.

"There is no treatment that will be effective for everyone, and we
need to have alternatives ready."

In the SALOME trial, roughly 200 addicts will be offered either
heroin or Hydromorphone in double-blind tests. In a second stage,
researchers will offer subjects the same drugs in pill form to test a
safer alternative to injection treatment.

Dr. Oviedo-Joekes noted that between 15 and 25 per cent of people who
have tried methadone to break their habit have ended up back on the
street using illicit drugs. That's the group from which the trial
will recruit addicts: "We are looking for people who have tried
[methadone] and are still using opiates daily in the street."

She noted that heroin treatment is still a tough sell in Canada,
although it is being tried in several European countries. But she
said it is a necessary step toward a more effective approach to drug
addiction problems that are so visible in Vancouver's Downtown Eastside.

"It's not one trial that is going to save the Downtown Eastside. It's
a vision of treating these most vulnerable people who deserve our
care and our time and our money."

Dr. Perry Kendall, the provincial health officer, said he supports
the medical trial.

"It's really valid research and it opens up options for different
treatment," he said in an interview. "If you could substitute
Hydromorphone, that doesn't have the stigma or the regulatory hoops
you have to go through if you are importing heroin. It becomes a lot
more feasible and a lot cheaper."

But he said a political commitment is needed to follow through in any
meaningful way.

"It will be nothing if we don't have the facilities to deliver it as
a specialized treatment," he said. "At the moment we are facing some
tough choices in a very tight budget year, and that's where some of
the issues of stigma come in because you're competing with highly
expensive cancer treatments and hip replacements for people who have
worked all their lives."