WHEN ALL ELSE FAILS, THERE'S FREE HEROIN

Bold Experiment Seeks Ways To Stabilize Addicts' Lives

The federal government is paying for free heroin -- again.

Controversial research that involves giving free heroin to Vancouver
addicts is about to enter a second phase, this time with a treatment
regime never before tried anywhere in the world.

Starting next spring, addicts reporting to a Downtown Eastside clinic
will be given, for injection, either free heroin or the opium-based
pharmaceutical drug hydromorphone, also called Dilaudid. Midway
through their one-year stints in SALOME (Study to Assess Longer-term
Opioid Medication Effectiveness), addicts will be switched to orally
administered formulations of the same drugs.

A total of 322 addicts will each go through a year of treatment, with
the three-year project costing $8 million.

The federally and locally funded research targets addicts who have
been through addiction-treatment programs and heroin-substitute
methadone therapy but have remained severely addicted to heroin.

"The treatments we have been providing have failed to keep these
people far from drugs," said Eugenia Oviedo-Joekes, a lead SALOME
investigator who came to St. Paul's Hospital after conducting
free-heroin research in Spain. "We have been defeated by reality, at
least for today."

For hard-core addicts who can't quit, society is left with the choice
of letting them lead miserable lives which cost taxpayers dearly, or
trying to find a solution that minimizes the damage and provides some
hope of improving their lives, Oviedo-Joekes said.

"We aim for the poor guys that have been left behind by society, by
the health-care system," she said.

The federal Canadian Institutes for Health Research has given approval
to SALOME, and is expected to contribute $1 million. B.C.'s Providence
Health Care, a Quebec provincial health authority and private donors
will provide the rest of the funding.

Two successful businesspeople and another philanthropist have
committed $500,000 for the research, said Trish Walsh, executive
director of the Inner Change Foundation, which is raising money for
SALOME. Former Tory MP John Reynolds sits on the SALOME board.

"There's tremendous

interest in looking for an effective solution to the Downtown
Eastside," Walsh said.

The project appeals to people across the political spectrum because it
produces measurable results and carries the hope of reducing the
economic costs addiction imposes on society, Walsh said.

SALOME follows NAOMI (North American Opiate Medication Initiative),
which also gave addicts substitutes for street heroin.

In NAOMI, 115 addicts in Vancouver and Montreal received medical
heroin, 111 received methadone, and 25 received Dilaudid, starting in
March 2007. The study found addicts on the medical heroin had more
success with staying in treatment or kicking drugs entirely -- 87 per
cent -- than those on methadone, with a 54-per-cent success rate.

But those on Dilaudid, at 88 per cent, did even better.

The number of participants committing crime dropped from 70 per cent
to 36 per cent, and the amount of money they spent on street drugs
dropped by almost half, according to the study.

Participants' health indicators improved 27 per cent.

A NAOMI participant, Jennifer, said she'd started using heroin after
her twin 12-year-old boys and husband died in a boat explosion, and
she also began smoking crack and working as a prostitute. After NAOMI,
in which she received Dilaudid, she cut her illegal drug purchases
from $3,000 a month to $200, quit sex work and got into a methadone
program, she said.

Critics charged that NAOMI's results were unreliable because they came
from addicts' self-reporting.

A group of 26 Canadian addictions doctors authored a critique of the
NAOMI trial's design and interpretation of results, stressing that
there were several adverse reactions in the Dilaudid group. They
concluded "the establishment of hydromorphone injection clinics in
B.C. is premature. Such a clinic will be expensive and of unproven
efficacy and safety, and it may result in hydromorphone . . . abuse."

University of Toronto addictions specialist Dr. Meldon Kahan believes
the NAOMI trials set up methadone treatment to fail, using low doses
and providing poor supports.

"NAOMI advocates claim their treatment is intended for patients who
have failed at methadone treatment, and therefore the choice is
between free heroin or street heroin," Kahan said. "But in fact NAOMI
patients did not receive high-quality methadone treatment, with
optimal dosing and counselling."

It costs $7,500 a year to treat an addict under the NAOMI and SALOME
models, whereas health and legal-system costs for addicts in general
run at $50,000 a year, said NAOMI lead investigator Martin Schechter.

SALOME researchers hope to find out if Dilaudid can accomplish what
prescribed heroin did, making it easier to fund and run Dilaudid-based
treatments, which don't carry the stigma of heroin. Researchers also
want to discover whether orally taken heroin and Dilaudid can work as
well as injected formulations, to cut needle-use risks.

Additional goals of SALOME include reducing illicit drug use, cutting
the profits of organized crime, improving health, reducing
addiction-related theft and, if possible, getting participants to
conquer their addictions.

"Our aim is that you can function," Oviedo-Joekes said, "that you can
get a roof, that you can be back working, if you can, that you can
have bonds with the community, if you can, that if you're mentally
ill, that you can get [professional] attention."