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."
It took more than a year for study organizers to get regulatory approvals to import heroin and to gather the finances, which are coming in part from the private sector. A second clinic was planned for Montreal but without the authorization, the researchers decided to proceed with just one.
The research arm of Health Canada has approved the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) as a way to examine alternate therapies for addicts who have not responded to conventional methadone treatment.
The researchers will attempt to determine if heroin addicts will accept an alternate narcotic that is legally available in Canada, and will examine if providing those drugs in a pill form, rather than by injection, is effective. If successful, Ms. Walsh said, it would be a groundbreaking new treatment in a field where few options are available, especially in Canada.
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 and troubling aspects of heroin addiction, such as committing crimes, sharing needles and shooting up in back alleys.
The clinical trial builds on an earlier Canadian heroin trial, the North American Opiate Medication Initiative (NAOMI). The researchers found that participants who were given heroin in a clinic were healthier and committed fewer crimes to pay for their habits.
The results of NAOMI were published in the New England Journal of Medicine last August and garnered international media attention. A small portion of the participants in that study were given Hydromorphone to serve as a control group, and researchers were surprised to discover how effective it seemed to be. This study will test the drug more broadly to see if it can be proven to work as a substitute.
Ms. Walsh said the success of the NAOMI study will ensure this trial will be followed closely. "NAOMI showed there are solutions to helping to end the crisis in the Downtown Eastside," she said.
But for a wider audience, there is considerable interest in a treatment that does not involve injection drugs. Being able to take a narcotic in pill form reduces the need for medical staff at the clinic, and also reduces the stigma when persuading policy makers to approve treatment funding.
Although there has been little encouragement from the federal government for Insite, Vancouver's safe injection site, Ms. Walsh said the goal is to have heroin or Hydromorphone available as a treatment option.
"There are approximately 5,000 chronic addicts in the Downtown Eastside," she noted. "So there is so much more we have to do. This is a very exciting trial, but the goal is to have this as a model for treatment in Vancouver and across Canada."
In January, the research team will finalize the location of the Vancouver clinic and will begin consultations with stakeholders in the Downtown Eastside. They'll begin taking applications for clients in February.
Participants must be adults and, as in the NAOMI trial, must be able to demonstrate that methadone treatment has failed them.