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Drug could help cut through red tape, politics of supervised injection

A legal drug known as Dilaudid that is very similar to heroin could be used to treat addicts at a Downtown Eastside clinic at a cost of only $1.5 million a year.

But it's up to the province and City of Vancouver to pony up the cash, said Dr. Martin Schrechter, lead researcher of the first study in North America to use supervised heroin injection to treat addicts.

Results from the three-year study, called the Northern American Opiate Medication Initiative, or NAOMI, were released at a press conference today.

The NAOMI clinic opened in 2005 to 251 patients in the Downtown Eastside, a majority of whom were middle-aged aboriginals who had been injecting heroin for an average of 17 years. Now that the study is over, the clinic is closed.

The goal, said Schrechter, was to find out how long-time addicts who had failed methadone treatment before would respond to injections of pharmaceutical heroin, or diacetylmorphine (DAM).

Half the patients received received methadone orally once a day, and half received DAM three times a day.

Results showed that 67 per cent of people injecting at the clinic, versus 47 per cent of those taking methadone, improved over a period of twelve months.

They were using illicit heroin and cocaine less, they had better physical and mental health scores and they committed fewer crimes and spent less money on street drugs.

The effectiveness of Dilaudid, a prescription pain-reliever, was a surprise, said Schrechter. Initially, they had given it to a small group of injection patients to gauge honesty about illicit heroin use, which is indistinguishable from DAM in the urine.

“Based on the preliminary evidence, they are equally effective,” said Schrechter. "The important thing is to offer what we can offer now."

Right now, Dilaudid would have to be licensed by the federal government or given off-label approval by the B.C. College of Physicians and Surgeons to be used for addiction treatment.

It’s still a lot easier than the “tremendously complex” process of handling DAM, says Ann Livingston, executive program director of the Vancouver Area Network of Drug Users.

“Most people feel very impatient that these artificial barriers are put in the way of proven medical treatments,” said Livingston.

“The biggest question we have is how can we put political pressure to get this program implemented rather that watching the study end and disappear.”

Schrechter pointed out that similar heroin treatment clinics in in Switzerland and Holland were funded to continue serving patients after trials were complete.

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