InnerChange Foundation

Mental health services need new approach to be effective

Fri, 21 Oct 2011 11:44:43 -0800

By John Reynolds And Stephen Toope

Media reports of those suffering with mental illness and severe addiction in British Columbia, and the Downtown Eastside of Vancouver in particular, have reached a level that may convey a sense of hopelessness. The release of the Vancouver Police Department report Policing Vancouver's Mentally Ill: The Disturbing Truth, as well as reports regarding deteriorated conditions at the psychiatric ward at Vancouver General Hospital and patient access to illegal drugs, could lead one to conclude that this will continue to be a significant drain on our policing and health care resources. This sense of hopelessness serves only to support proposals that the best solution to deal with severe addiction is isolationist (Drug Addicts Should Be Sent to Isolated Work Camps, Vancouver Sun, Sept. 14), which is more reminiscent of the archaic notion of leper colonies than it is a reasonable treatment strategy.

There is no doubt that problems created by those suffering from mental illness and severe addictions are costly to society in both financial and human terms. Some estimate that approximately 55 per cent of Vancouver's Downtown Eastside population of 18,000 are suffering from severe addiction and mental illness. The VPD reports that on average one third of all police calls for service involve one or more persons apparently suffering from a mental health issue, and this is true for one of every two calls in the DTES. The police have become "society's de facto 24/7 mental health workers."

It is clear that we need a renewed approach. As a society, we simply cannot afford to give up on improving the effectiveness of treatment for those suffering from mental illness and severe addiction.

One group of researchers, health care workers and community service providers is brainstorming an integrated approach that we think policy-makers and community members should support.

There is an urgent need to integrate mental health and addiction treatment systems and remove the silo approach to services in the Downtown Eastside, and beyond. The formulation of a better co-ordinated provincial model could provide a much more efficient use of scarce resources in our health system, community services and policing departments.

Two local examples give us a blueprint: the BC Cancer Agency and the B.C. Centre for Excellence in HIV/ AIDS. In both cases, the integration of research, training and clinical services, combined with the provincial co-ordination these centres provide, greatly improved outcomes for those with cancer and HIV/AIDS in B.C. and elsewhere.

Applying this model to mental illness and severe addiction would help tie together continuing initiatives, existing capacities, and future programs through best practice development, direct coordination of research and clinical treatment, training, and continuous evaluation.

We already have the necessary components of such a model. Imagine if we were able to effectively tie these together: world-class research conducted at University of British Columbia and other institutions, non-profit foundations such as Inner Change Foundation, policing agencies such as the VPD, mental health and addiction services, health authorities and health care professionals, and provincial leadership via the Ministry of Health.

Bringing these all together via a new B.C. Centre for Excellence would permit economies of scale, shared learning and the ability to directly coordinate both research and clinical treatments.

Dr. Michael Krausz, the UBC/Providence Health Care LEEF Chair in Addiction Research has said, "To provide innovative and more effective treatment you need clinical research, to do world-class clinical research you need innovative treatment facilities, and to train the next generation of experts you need both."

The VPD said it well in its report: We owe it to our most vulnerable citizens "to keep working toward more responsive and effective models of care for the mentally ill and/or addicted in our society."

John Reynolds is a board member of Inner Change Foundation and Stephen Toope is president of the University of British Columbia.

Vancouver clinical trials to test effectiveness of pain reliever as heroin addiction treatment

Fri, 21 Oct 2011 11:39:23 -0800

By Randy Shore, Vancouver Sun

Clinical trials are set to begin in Vancouver on a study to test the effectiveness of the prescription pain reliever Dilaudid as a treatment for chronic heroin addiction.

The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) has just cleared a major regulatory hurdle by receiving permission from the federal government to import pharmaceutical heroin, according to Eugenia Oviedo-Joekes, a researcher for Providence Health Care and a professor at the University of British Columbia.

"So now we are importing the drug and starting recruitment at the end of this year," said Oviedo-Joekes.

The study will treat 322 heroin addicts who do not respond to conventional methadone or abstinence-based programs with either injectable heroin or injectable Dilaudid, an opiate pain reliever also known as hydromorphone. In the second phase of the study, half of the subjects from each group will transition to the oral form of the same medication to determine if they maintain the same level of effectiveness.

Researchers stumbled on Dilaudid as a candidate for the treatment of heroin addiction after the medication was administered to a small group of subjects in a previous study that compared the effectiveness of medically prescribed heroin with methadone therapy in hard-to-treat addicts.

The earlier study — dubbed NAOMI, the North American Opiate Medication Initiative — found that after 12 months 88 per cent of the subjects receiving heroin were still in treatment, compared with 54 per cent of the subjects who received methadone. Researchers were surprised to find that the group administered Dilaudid were just as likely to remain in treatment as the heroin group, though the size of the Dilaudid group was too small to draw robust scientific conclusions.

Should Dilaudid prove to be as effective as prescribed heroin, the researchers hope the finding would open the door to new treatment programs for hard core addicts without the regulatory challenges and political baggage of heroin-based treatment.

The federal government refused a request by NAOMI researchers to continue to administer heroin to the addicts who had benefited from the therapy, Oviedo-Joekes said.

Provincial health officer Perry Kendall called that decision "disappointing and short-sighted."

"In Germany, Holland and Spain and in the NAOMI trial here in B.C., [hard-to-treat addicts] were helped considerably by a stint on heroin and psycho-social counselling," Kendall said. "Many people in these studies are [over time] able to get off drugs entirely."

Kendall said the cost benefits of heroin maintenance are well established, as addicts are less likely to commit crimes to buy street drugs, less likely to deal street drugs and are less likely to need hospital care for illness or accidental overdose.

"If this [Dilaudid] study proves successful, it will gives us a second line of treatment for people who aren't helped by the current best practice, which is methadone," Kendall said.

Subjects for the study will be recruited through UBC's Downtown Eastside research office and through referrals from social service agencies and groups such as VANDU, the Vancouver Area Network of Drug Users.

"We will literally walk the streets to find addicts who are using in the street," said Oviedo-Joekes. "But it won't be hard to fill the spaces, people know about this and they are calling us [to get in]."

Due to space restrictions at the clinic, only 100 subjects can be in the study at a time. In the first phase of the study, subjects may report to the clinic for an injection up to three times a day.

Harper Tories endorse heroin research project

Fri, 21 Oct 2011 11:36:26 -0800

By Rod Mickleburgh, Globe and Mail

Days after the Supreme Court of Canada’s rejection of Ottawa’s hard-line approach to heroin addiction, the Harper government is endorsing a research project in Vancouver that administers free heroin to hard-core addicts.

The aim of the groundbreaking trial, known as SALOME, is to determine whether a powerful, but legal, opiate, hydromorphone, can wean injection drug users away from addictive drugs as effectively as simply giving them heroin itself.

It follows on a controversial clinical trial, which began under the federal Liberals, that did prescribe heroin to addicts in an effort to improve their lives and get them into treatment. The NAOMI experiment found that diehard addicts provided with free heroin were far more likely to remain in addiction treatment and much less prone to take street drugs and commit crimes to support their habit than those treated with methadone.

But prescribed heroin – commonplace in parts of Europe – remains a tough sell in Canada, particularly with a Conservative government in Ottawa, and hydromorphone could provide a more palatable alternative.

Should the opiate prove effective, it might also demolish a key argument for legalizing heroin.

“There’s less of a stigma, less of an aura around hydromorphone, and it’s legally available,” B.C.’s medical health officer, Perry Kendall, said Wednesday. “In Switzerland and Germany, they don’t have a problem with treating people with heroin, but here we do.”

The SALOME trial, funded by the federal Canadian Institute for Health Research and the province, will involve 322 difficult-to-treat heroin addicts. Half are to receive heroin, and half hydromorphone, with none knowing which opiate they are getting.

A small number of addicts enrolled in the earlier NAOMI trial were given the legal opiate, rather than heroin or methadone. Researchers were surprised to discover that they could not tell whether they had injected hydromorphone or heroin.

“And they reported the same results as those receiving heroin,” said SALOME investigator Eugenia Oviedo-Joekes. “But with such small numbers you can’t say much, so now we are going to test further to see if hydromorphone is as good as heroin, as a form of addiction treatment.

“Health Canada simply isn’t ready to consider treatment with heroin, and with hydromorphone you would then have a licensed medication as an alternative [to methadone],” Dr. Oviedo-Joekes said.

Steve Outhouse, spokesman for Health Minister Leona Aglukkaq, said the free heroin provided in the SALOME trial is different from Vancouver’s supervised, heroin injection site, which the Conservatives challenged all the way to the Supreme Court, and lost.

“This is medical research aimed at helping people get off drugs,” Mr. Outhouse said, explaining why Health Canada granted the trial an exemption from the narcotics act. “Yes, heroin, which is otherwise an illegal substance, will be used on site, but it will be used properly as part of a medical trial. We want people to get off drugs.”

Vancouver resident Dave Murray says he is living proof that heroin treatment works. After more than 20 years dealing and injecting drugs, Mr. Murray participated in the earlier NAOMI trial, where he regularly received doses of heroin without having to worry about his next fix.

The stability erased the stress from his life and prompted reflection, Mr. Murray said. “My brain re-engaged, and I made a conscious decision to try detox. I failed at first, but about three years ago, finally I stopped using.”

It took Health Canada 18 months to give SALOME the green light, but the only study of its kind in North America is now scheduled to start up early next year.

In addition to the effectiveness of hydromorphone, the trial will compare injecting the two drugs with taking them orally. Should oral consumption prove as effective, it might dramatically curtail the use of needles among hard-core addicts.

“Oral hydromorphone could become a very strong new asset in treating drug addiction,” said SALOME investigator Michael Krausz. “It could be a real compromise [in the drug wars], since the stigma of regulated pain medication would be something people could accept, even if they are Conservatives.”

Published on Wednesday, Oct. 12, 2011 9:47PM EDT

UBC-Providence Health research to examine new treatments for heroin addiction

Fri, 21 Oct 2011 11:35:20 -0800

A clinical trial to test better treatment options for chronic heroin addiction is expected to begin in Vancouver at the end of this year. Led by researchers from Providence Health Care and the University of British Columbia, it’s the only clinical trial of its kind in North America.

The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) is a carefully controlled three-year clinical trial that will test whether hydromorphone (Dilaudid®), a licensed pain medication, is as effective as diacetylmorphine, the active ingredient of heroin, at engaging the most vulnerable long-term street heroin users, so they will enroll in treatment programs and end their use of illicit drugs.

The intent of the SALOME project is to determine whether some participants become healthier and reduce their illicit drug use or are able to switch to other forms of treatment. SALOME also intends to test if, after stabilizing patients on injectable medications, they can transition to oral formulations without losing effectiveness.

This study builds on the North American Opiate Medication Initiative (NAOMI), which was North America’s first-ever clinical trial of prescribed heroin that took place from 2005 to 2008. NAOMI, which also was led by researchers from Providence Health Care and UBC, was a randomized trial aimed at testing whether medically prescribed heroin (diacetylmorphine) was more effective than methadone therapy for individuals with chronic heroin addiction who were not benefiting from other conventional treatments.

The results, published in the New England Journal of Medicine, showed that patients treated with the prescribed heroin were more likely to stay in treatment or quit heroin altogether and more likely to reduce their use of illegal drugs and other illegal activities than patients treated with oral methadone.

In the NAOMI study, the researchers also provided a small sample of patients with injectable hydromorphone, (Dilaudid®). An unexpected finding was that injection patients could not accurately discriminate whether they were receiving prescribed heroin or hydromorphone. The researchers also observed similar results and benefits with both these drugs although the small number of participants receiving hydromorphone did not permit any definite and scientifically valid conclusions to be drawn as to the efficacy of hydromorphone as a viable treatment option.

Should hydromorphone be proven to be as affective as heroin, the benefits of this form of injectable treatment may be more feasible and achievable without the emotional and regulatory barriers often presented by heroin maintenance.

SALOME, led by Dr. Michael Krausz, the Providence Health Care/UBC B.C. Leadership Chair in Addiction Research and Dr. Eugenia Oviedo-Joekes, Providence Health Care researcher and an assistant professor in UBC’s School of Population and Public Health, will enroll 322 individuals with chronic heroin dependency who currently are not sufficiently benefiting from conventional therapies, such as methadone treatment, at one site based in Vancouver, BC.

In the first stage, half of the 322 participants will receive injectable prescribed heroin, and the other half will receive injectable hydromorphone. Stage I will involve six-months of treatment. All volunteers retained in injection treatment at the end of Stage I will be eligible to enter Stage II.

In Stage II, half of the participants will then continue injection treatment exactly as in Stage I on a blinded basis while the other half will switch to the oral equivalent of the same medication (prescribed heroin or hydromorphone). Stage II will also involve six-months of treatment.

Throughout the treatment period, social workers will be assigned to both groups to assist them with reaching other addiction services and community resources such as counseling, housing and job training services.

Some 60,000 to 90,000 persons are affected by opioid addiction in Canada. This study will enroll the most chronically drug-dependent members of Vancouver’s population — those who are not benefiting from other treatments, such as methadone therapy and abstinence-based programs, and continue injecting street heroin.

“SALOME addresses critical social and ethical concerns dealing with addiction. Opioid-dependent people are in need of treatment options to avoid marginalization from the health care system and this study aims to answer questions that could lead to improvements in the health of persons with chronic addictions and identify new ways of reintegrating this population into society,” says Dr. Perry Kendall, B.C.’s Provincial Health Officer. “If the SALOME study shows that hydromorphone can go head-to-head with heroin as an alternative therapy for people who have failed optimally provided methadone, then I think this should be part of the treatment continuum that’s available through licensed physicians.”

The SALOME study is funded by the Canadian Institutes of Health Research, the Government of Canada’s agency responsible for funding health research in Canada, Providence Health Care and the InnerChange Foundation.

For more information on SALOME, please visit www.providencehealthcare.org/salome/index.html

About Providence Health Care
Providence Health Care is one of Canada’s largest faith-based health care organizations, operating 15 facilities within Vancouver Coastal Health. Guided by the principle “How you want to be treated,” PHC’s 1,200 physicians, 6,000 staff and 1,500 volunteers deliver compassionate care to patients and residents in British Columbia. Providence’s programs and services span the complete continuum of care and serve people throughout B.C. PHC operates one of two adult academic health science centres in the province, performs cutting-edge research in more than 30 clinical specialties, and focuses its services on six “populations of emphasis”: cardiopulmonary risks and illnesses, HIV/AIDS, mental health, renal risks and illness, specialized needs in aging and urban health.

About the University of British Columbia

The University of British Columbia (UBC) is one of North America’s largest public research and teaching institutions, and one of only two Canadian institutions consistently ranked among the world’s 40 best universities. Surrounded by the beauty of the Canadian West, it is a place that inspires bold, new ways of thinking that have helped make it a national leader in areas as diverse as community service learning, sustainability and research commercialization. UBC offers more than 50,000 students a range of innovative programs and attracts $550 million per year in research funding from government, non-profit organizations and industry through 7,000 grants.

NAOMI: See video series

Thu, 28 Jul 2011 14:20:18 -0800

NAOMI: See video series

Landmark heroin Study Could Transform Lives

Thu, 28 Jul 2011 14:20:00 -0800

Landmark heroin Study Could Transform Lives

Heroin better for addicts in recovery: Study

Mon, 28 Feb 2011 20:18:36 -0800

Tiffany Crawford, Canwest News Service - Link

OTTAWA — A Canadian study that found giving heroin to hardcore drug addicts at a supervised clinic leads to a higher rate of recovery than giving them methadone was published Thursday in the prestigious New England Journal of Medicine.

The study, titled North American Opiate Medication Initiative (NAOMI), studied whether heroin-assisted therapy benefits people who suffer from opiate addictions. The study was released in October 2008, but was not published until Thursday.

The NAOMI report concluded that injecting addicts with diacetylmorphine, the active ingredient in heroin, was more effective than oral methadone.

Canadian scientists monitored 251 drug addicts in Montreal and Vancouver, the two cities with the largest heroin-addicted populations in Canada. The participants got drugs for 12 months under the supervision of nurses, doctors, psychiatrists and social workers.

During the trial, 115 addicts received the medical heroin, 111 received methadone and 25 received hydromorphone — a licensed opiate for pain relief — starting in March 2007.

The study found that those on the diacetylmorphine had an 88 per cent better chance of kicking the habit, compared to 54 per cent in the methadone group. Further, the reduction in rates of illicit-drug use or other illegal activity was 67 per cent in the diacetylmorphine group and nearly 48 per cent in the methadone group.

Dr. Martin Schechter, one of the lead researchers of the study, said the publication of their work "feels like a vindication" of the criticism the study has received. One such criticism was speculation that addicts may report false results to increase their chance of more free drugs in the future.

"The New England Journal of Medicine is one of the most prestigious journals in the world and it's a validation of the quality of the scientific work we have done," he said. "It puts the best seal of approval on a study and that does have an affect on policy-makers."

Schechter said an editorial in the journal points out that giving addicts heroin is not a new idea and that the method has resurfaced in Europe and now North America.

Following NAOMI, a further study was announced in June called SALOME — Study to Assess Longer-term Opioid Medication Effectiveness. Schecter, who will be also involved in that study, said they are currently trying to secure funding for the project. The SALOME will give more than 200 addicts in Montreal and Vancouver heroin treatment in pill and injectable forms.

With the new study, scientists hope to prove that hydromorphone is just as effective as prescribing heroine to treat addicts. Schechter said the addicts given the hydromorphone could not tell the difference from heroin.

"It would be effective where heroin is a non-starter because of political reasons, for example (in) the United States where they would use a licensed opiate for pain," he said. "If we could prove this, then it could be licensed for addiction."

In the editorial in Thursday's Journal, Virginia Berridge says the findings of the Canadian study are widely supported in Europe, but have not been in the United States. The Australian government discontinued a heroin trial in the 1990s.

"The results of this trial may be added to those from Germany, the Netherlands, Spain and Switzerland," Berridge said. "Switzerland has 10 years of experience in the prescription of heroin, and in a November 2008 referendum, 68 per cent of voters were in favour of its continued prescription."

Meantime, the Harper government opposes Insite, a Vancouver-based facility that allows drug users to inject heroin and cocaine under medical supervision, and is embroiled in a legal battle to shut it down. The site, which opened in 2003, is supported by local and provincial governments.

The federal government argues money should not be spent on drug use, instead directing funds toward prevention and treatment of substance addiction.

Read it on Global News: Heroin better for addicts in recovery: Study

Study Backs Heroin to Treat Addiction

Mon, 28 Feb 2011 19:59:26 -0800

Story courtesy New York Times is here:

http://www.nytimes.com/2009/08/20/health/research/20heroin.html?_r=1

By BENEDICT CAREY

The safest and most effective treatment for hard-core heroin addicts who fail to control their habit using methadone or other treatments may be their drug of choice, in prescription form, researchers are reporting after the first rigorous test of the approach performed in North America.

For years, European countries like Switzerland and the Netherlands have allowed doctors to provide some addicts with prescription heroin as an alternative to buying drugs on the street. The treatment is safe and keeps addicts out of trouble, studies have found, but it is controversial — not only because the drug is illegal but also because policy makers worry that treating with heroin may exacerbate the habit.

The study, appearing in the current issue of the New England Journal of Medicine, may put some of those concerns to rest.

“It showed that heroin works better than methadone in this population of users, and patients will be more willing to take it,” said Dr. Joshua Boverman, a psychiatrist at Oregon Health and Science University in Portland.

Perhaps the biggest weakness of methadone treatment, Dr. Boverman said, is that “many patients don’t want to take it; they just don’t like it.”

In the study, researchers in Canada enrolled 226 addicts with longstanding habits who had failed to improve using other methods, including methadone maintenance therapy. Doctors consider methadone, a chemical cousin to heroin that prevents withdrawal but does not induce the same high, to be the best treatment for narcotic addiction. A newer drug, buprenorphine, is also effective.

The Canadian researchers randomly assigned about half of the addicts to receive methadone and the other half to receive daily injections of diacetylmorphine, the active ingredient in heroin. After a year, 88 percent of those receiving the heroin compound were still in the study, and two-thirds of them had significantly curtailed their illicit activities, including the use of street drugs. In the methadone group, 54 percent were still in the study and 48 percent had curbed illicit activities.

“The main finding is that, for this group that is generally written off, both methadone and prescription heroin can provide real benefits,” said the senior author, Martin T. Schechter, a professor in the School of Population and Public Health at the University of British Columbia.

Those taking the heroin injections did suffer more side effects; there were 10 overdoses and six seizures. But Dr. Schechter said there was no evidence of abuse. The average dosage the subjects took was 450 milligrams, well below the 1,000-milligram maximum level.

About 663,000 Americans are regular users of heroin, according to government estimates. The researchers said 15 percent to 25 percent of them were heavy users and could benefit from prescription heroin. That is, if they ever were to get the chance. Heroin is an illegal, Schedule 1 substance, meaning it has a high potential for abuse and serves no legitimate medical purpose. That designation is unlikely to change soon, researchers suspect.

In an editorial with the article, Virginia Berridge of the London School of Hygiene and Tropical Medicine concluded, “The rise and fall of methods of treatment in this controversial area owe their rationale to evidence, but they also often owe more to the politics of the situation.”

Dr. Michael Krausz speaks at Sam Sullivan's Feb. 2011 Public Salon

Tue, 22 Feb 2011 12:56:45 -0800

InnerChange Foundation research advisor Dr. Michael Krausz

Can pill replace heroin for addicts?

Thu, 17 Feb 2011 12:38:18 -0800

Can pill replace heroin for addicts? See report by CTV.

"Kicking Heroin" reported on CBC Connect with Mark Kelley

Wed, 02 Jun 2010 09:21:49 -0800

CBC's Mark Kelley talks with former heroin addict Dave Murray about a U.K. medical journal study that suggests treating addicts with supervised, injectable heroin leads to significantly lower use of street heroin

See video here.

CTV reports on latest heroin study

Wed, 23 Dec 2009 12:29:23 -0800

See the story here:

http://watch.ctv.ca/news/latest/heroin-study/#clip249163

Landmark heroin study set to begin in Vancouver

Tue, 22 Dec 2009 12:26:44 -0800

Treatment clinic, part of SALOME research, will examine therapy for addicts who have not responded to methadone

by Justine Hunter, Victoria

Just weeks before the spotlight hits Vancouver for the 2010 Winter Olympic Games, a landmark medical study is set to begin, drawing attention to the one class of Vancouverites that the city doesn't want to showcase: Heroin addicts.

The four-year trial will provide 322 chronic addicts at a private Vancouver clinic with heroin or a legal substitute opiate, Hydromorphone.

"This could revolutionize heroin treatment internationally," said Trish Walsh, executive director of the InnerChange Foundation. "It's exciting to start this before the Olympics, we think it's a great opportunity treat the root cause of homelessness in the Downtown Eastside."

Groundbreaking Addiction Research Trial Ramps Up in January

Tue, 22 Dec 2009 09:37:55 -0800

More Vancouver Participants Than Originally Anticipated Inner Change received our Christmas present early this year with confirmation in June from the Canadian Institutes of Health Research that they will invest $1 million to support our medical trial to offer people with heroin addiction in Vancouver's Downtown Eastside (DTES) a legal medicine in pill and injectable forms as an alternative to injectable heroin. This study to assess the effectiveness of longer-term Hydromorphone medication (SALOME) will allow some of the world's leading addictions researchers to follow-up on the groundbreaking results of the North American Opiate Maintenance Initiative (NAOMI) which were published this summer in the New England Journal of Medicine. NAOMI was a carefully controlled clinical trial which tested whether medically prescribed heroin could successfully attract and retain street-heroin users who have not benefited from previous repeated attempts at participating in methadone maintenance and abstinence programs. NAOMI concluded that new substitution treatment alternatives to methadone can:

improve health outcomes for long term chronic addicts who have not benefited from previous repeated attempts at participating in methadone and abstinence programs
significantly reduce crime in our community
save both the justice & health care systems millions of taxpayer dollars

Here are the details: SALOME Starts After spending the better part of 2009 working on funding and various regulatory approvals, SALOME will likely be moving into our implementation phase prior to the start of the Winter Olympic and Parlaympic Games. In January the research team will be working ensuring that the Vancouver clinic satisfies the various specifications required under federal regulations. They will also maintain ongoing discussions with regulatory authorities to ensure SALOME complies with the protocols required with an innovative project like this. Also in January, Inner Change will initiate a series of community information sessions with DTES community stakeholders, the media, business leaders and Chinese community to:

recap project goals and objectives
highlight rules, procedures & research methods
describe intake & eligibility process
discuss ongoing consultation options

More Vancouver Participants As happy as we are to report the start of SALOME, we are equally excited about the fact that we will be able to offer addiction treatment to more people in Vancouver than we originally anticipated. The current projection indicates that 322 participants will be involved in the trial over four years. With the collaboration of government partners, private donors, community leaders and our research team, we will have an opportunity to reach over 322 people for who have not benefited from all other avaiable programs. In addition to reducing the illegal heroin profits of organized crime, we can re-build lives and show the world that Vancouver is doing everything it can to help many of our most vulnerable citizens. With the world arriving at our doorstep in the New Year, we know the rampant drug addiction and mental illness problems in the DTES will be a black eye for our city. At the same time it will be an opportunity to highlight SALOME and other innovative initiatives as a demonstration of how Vancouver is on the leading edge of international addictions research for a population in desperate need of alternate health options. SALOME: What others have said lately: "It's really valid research and it opens up options for different treatment. 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." - Dr. Perry Kendall, Chief Provincial Health Officer, Province of British Columbia "When you combine our findings with the findings of the NAOMI study, it's pretty clear not only do the people in the program benefit, but we all benefit. The participants are involved in less crime and there is no impact on the community." - Prof. Neil Boyd, Simon Fraser University Criminologist "If we can show this works, why wouldn't we move towards that kind of help for people who are addicts. Is there really any difference from one disease to another - or from one addiction to another? Anything that thinking people can do to help people get rid of that illness is a good idea. This is a non-partisan thing. This is about people helping people." - Hon. John Reynolds, former Conservative MP and BC Social Credit Cabinet Minister "Our government recognizes that injection drug users need assistance. That's why we are investing in prevention and treatment, to help people recover from their drug addictions." - Ms. Josée Bellemare, Office of the federal Minister of Health

New England Journal of Medicine Publishes Results of Groundbreaking BC Addiction Research Trial

Thu, 20 Aug 2009 13:54:08 -0800

Read the Press Release.

Let them take heroin, study says

Thu, 20 Aug 2009 13:40:44 -0800

By Karen Kaplan, Los Angeles Times To improve the chances that hard-core heroin addicts will stick with their treatment for opioid dependence and forgo the use of illicit drugs, they should take ... heroin. That's the controversial conclusion of a study being published in Thursday's edition of the New England Journal of Medicine. Heroin The study focused on addicts who took heroin for at least five years and had already failed two attempts at treatment. One of those attempts had to involve methadone, which helps manage heroin cravings and blocks the drug's euphoric effects.

Heroin helps addicts in recovery: study

Thu, 20 Aug 2009 13:39:10 -0800

More effective than methadone. 251 Montreal, Vancouver drug users monitored By TIFFANY CRAWFORD, Canwest News Service A Canadian study that found giving heroin to hard-core drug addicts at a supervised clinic leads to a higher rate of recovery than giving them methadone was published yesterday in the prestigious New England Journal of Medicine. The study, titled North American Opiate Medication Initiative, studied whether heroin-assisted therapy benefits people who suffer from opiate addictions. The study was released in October 2008, but was not published until yesterday. The NAOMI report concluded that injecting addicts with diacetylmorphine, the active ingredient in heroin, was more effective than oral methadone.

New England Journal of Medicine Publishes Groundbreaking Study Finding

Wed, 19 Aug 2009 13:56:32 -0800

Read the US Drug Policy Alliance press release

Treating heroin addiction with heroin seems viable

Wed, 19 Aug 2009 13:35:47 -0800

Byline: Gene Emery, Reuters Injections of the active ingredient of heroin work far better than oral methadone for keeping addicts in treatment, away from illegal drugs and out of trouble, Canadian researchers reported on Wednesday. But the researchers cautioned that the treatment carries a risk of overdose and seizures, so the injections should only be done in a medical setting. "Methadone, provided according to best-practice guidelines, should remain the treatment of choice for the majority of patients," Eugenia Oviedo-Joekes of the University of British Columbia and colleagues wrote in the New England Journal of Medicine.

Study Backs Heroin to Treat Addiction

Wed, 19 Aug 2009 13:33:32 -0800

By BENEDICT CAREY, New York Times The safest and most effective treatment for hard-core heroin addicts who fail to control their habit using methadone or other treatments may be their drug of choice, in prescription form, researchers are reporting after the first rigorous test of the approach performed in North America. For years, European countries like Switzerland and the Netherlands have allowed doctors to provide some addicts with prescription heroin as an alternative to buying drugs on the street. The treatment is safe and keeps addicts out of trouble, studies have found, but it is controversial -- not only because the drug is illegal but also because policy makers worry that treating with heroin may exacerbate the habit. The study, appearing in the current issue of the New England Journal of Medicine, may put some of those concerns to rest.

When all else fails, there's free heroin

Mon, 13 Jul 2009 21:59:07 -0800

Bold experiment seeks ways to stabilize addicts' lives By Ethan Baron, The Province 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 regimen 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.

From downtown ashes to a Canadian Phoenix?

Mon, 13 Jul 2009 21:57:21 -0800

We need to assure the human right of health for those still in the shadow By Dr. Michael Krausz, B.C. Leadership Chair for Addictions Research, originally published in The Province No one should be surprised about the situation in the heart of Vancouver -- the growing homelessness, the lack and quality of services, the lack of access and capacity. Nobody should be surprised, because it is not a priority and never was. Those on whom society has turned its back -- the mentally ill, intravenous drug users and cognitively impaired people -- are still living in the shadows of society, in the darkness of back alleys and in the lonely destitution of single-room-occupancy hotels. They die after an often miserable life, on average 20 to 30 years earlier than those living only blocks away, with no superhero at their side. The world will come to Vancouver and will ask a lot of questions. What answers would I like to hear and to give in a few months' time?

Reynolds: SALOME a new way out for addicts

Mon, 13 Jul 2009 21:54:46 -0800

By John Reynolds, originally published in The Province One of the reasons I am a proud supporter of Vancouver's Inner Change Foundation and research like the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) is because our health-care system needs to offer a wider array of effective treatment options for some of our most vulnerable citizens suffering from chronic drug addiction. By providing a new option that stabilizes addicts, transitions to legal oral medication and offers psycho-social treatment to address the underlying causes of addiction, SALOME represents hope and something average- thinking people can participate in to help our neighbours in the Downtown Eastside and beyond. It is about time that we end the stigma around addiction and start thinking about this as treatable illness instead of a moral failing. SALOME is a client-centred, integrative treatment model.

Provincial report asks government to recognize addiction as a disease

Thu, 09 Apr 2009 11:13:08 -0800

By: Jackie Wong, West Ender Approximately one in 10 people in B.C. suffers from some form of addiction or dependence, and 30 per cent of people diagnosed with mental illness will also have a substance-abuse disorder in their lifetime, according to a report released by the B.C. Medical Association (BCMA). Given these statistics, the report calls on the provincial government to formally recognize addiction as a chronic, treatable disease. Such a designation could pave the way toward better treatment, says Dr. Shao-Hua Lu, a BCMA addictions psychiatrist and the lead author of the paper. Continue reading: http://www.westender.com/articles/entry/provincial-report-asks-government-to-recognize-addiction-as-a-disease

Vancouver's Inner Change Foundation Strongly Supports BCMA Call to Recognize Addiction as a Chronic Disease

Fri, 27 Mar 2009 11:10:17 -0800

"Investments in treatment can also hit gangs in the pocket book" The Inner Change Foundation, a Vancouver-based society supporting the development of innovative drug treatment solutions, today expressed their strong support for the British Columbia Medical Association (BCMA)'s call to recognize addiction as a chronic disease. At the same time, the Foundation also noted that investments in proven treatment can save money by hitting organized crime in the pocket book. "We agree with BCMA that governments need to focus new investments on treatment that will pay dividends for the individual addict - and society as a whole," said Inner Change Executive Director Trish Walsh. "The status quo is not meeting the basic needs of our most vulnerable citizens and feeding the growing profits of organized crime in the Lower Mainland." The Inner Change Foundation says the solution to the problem must include strategically breaking the connection between the personal addiction and the profit of organized crime.