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."