For Dianne Tobin, who first tried heroin when she was 17 and has been a hard-core user since she was 33, finding a way out of the life of an addict has been a series of dead ends.
Rehab has not worked. She hated methadone, currently the only legal drug substitute prescribed for heroin users.
A few years ago, it seemed like there was another possibility when Ms. Tobin got free pharmaceutical-grade heroin for 18 months through the Vancouver- and Montreal-based NAOMI drug trial. Her life turned around when she did not have to be out on the streets hustling money for drugs.
But when the trial ended in 2009, Health Canada, under the Conservative government, would not give the exemption needed for people in the trial to keep getting the drug, as was done in other countries looking for ways to stabilize the lives of heroin users and bring them into a psychological state conducive to treatment and recovery.
Now a team of Vancouver researchers thinks it has found a substitute that might help Ms. Tobin and thousands of others in Canada. And it does not need federal approval.
Hydromorphone is a lab-produced substance that creates almost the same physical effects as heroin.
It is being tested in a follow-up trial to NAOMI by the University of B.C. and Providence Health Care researchers. But, unlike the heroin in NAOMI, hydromorphone is a legal pain medication.
Once Ms. Tobin finished her time in the new trial, called SALOME, she and about nine others were allowed to join a pilot project and continue getting hydromorphone through prescriptions from a Providence health-care team.
For Ms. Tobin, it feels like a good end to a long battle.
"It fixes something in me," said the 63-year-old, who has been getting involved in community work and going to regular counselling in the past few years.
Researchers and doctors hope they have found a treatment drug that is almost as good as heroin, but without the emotional and legal complications.
"The problem with prescribing pharmaceutical-grade heroin is that it is a very volatile subject for many," said Dr. Eugenia Ovieda-Joekes, one of the researchers with the SALOME trial. "As well, getting heroin into a country is very difficult."
The SALOME trial has another 18 months to run, and will eventually involve 322 people. At the end, researchers will see whether the hydromorphone trial produces all the same positive results as NAOMI did with heroin.
The NAOMI trial, similar to studies in countries like Germany and Switzerland, showed that users who got a reliable supply of heroin were more likely than those on methadone or using street drugs to establish stable lives. They were less likely to end up in jail, they held onto jobs, they were kicked out of housing less, and they stayed in treatment and counselling more consistently.
But since the Canadian government shows no sign of being willing to allow heroin to be prescribed for long-term maintenance, researchers here are hoping hydromorphone is a Canadian-made solution.
"Hydromorphone hasn't been used by any other countries," said Scott Harrison, the director of urban health and HIV for Providence Health Care in Vancouver, whose team has been prescribing hydromorphone for those who want to continue after their time in the SALOME trial. "We're trying to give care providers another tool."
Dr. Harrison said the hope is that users will not take hydromorphone forever. But that having the drug consistently available means they do not have to commit crime and they can live calmer lives.
"That allows us to get at the underlying causes why they are using the drug. The whole intention behind heroin or hydromorphone is to get people to the point where they don't need it."
Hydromorphone for each person in the current SALOME trial costs $39 a day, Dr. Harrison said. However, use typically goes down the longer people get it, he added.