The Quebec government's decision to cut $600,000 in funding from a study that would give heroin to hard-core drug addicts jeopardizes research into the controversial treatment that would have been a worldwide first.
Doctors involved say they're baffled by the decision, which came to light the same week research from a separate study was published that said giving heroin to people with entrenched addictions was far more effective than administering methadone. The provincial government said the decision has nothing to do with the study's merits, it just has more urgent uses for the money.
The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) would have been the first in the world to compare the effectiveness of medically prescribed heroin against Hydromorphone, a licensed narcotic and whether users will accept the drug in pill form instead of injecting it.
But without funds for its Quebec arm, the research may not go forward, said Martin Schechter, director of the school of population and public health at the University of British Columbia. If the Montreal clinics can't operate, Vancouver will take on the entirety of the trial's cost, making for a much longer and more expensive study, or the trials could be cancelled.
Suzanne Brissette, head of addiction medicine services at Montreal's Saint Luc hospital, said the cuts make no sense from an ethical or scientific perspective.
"For the people for whom it's the only option, it's telling them, 'Sorry, we're going to leave you where you are,' which is for me unacceptable and unethical. ... Scientifically it makes no more sense: The results were published in an excellent journal and they're solid."
SALOME was meant as a follow-up to the North American Opiate Medication Initiative (NAOMI), in which heroin and methadone were given to patient control groups at clinics in Vancouver and Montreal. The NAOMI results, published in the New England Journal of Medicine last week, show patients treated with the active ingredient in heroin are 62 per cent more likely to remain in addiction treatment and 40 per cent less likely to take street drugs and commit crimes to support their habit than those given methadone.
The Quebec Health and Social Services Ministry said the funds were withdrawn as a cost-cutting measure a couple of weeks ago because it was felt that the money would be better spent funding treatment for a wider range of people, said Harold Fortin, press secretary for Health and Social Services Minister Lise Thériault.
"For now, we would rather invest the $600,000 that was supposed to go to phase two into different types of projects that could reach a greater number of people that have different types of addictions."
Dr. Schechter said results from the SALOME study could have given health-care providers around the world another option for dealing with heroin addicts commonly written off as untreatable.
"The fact that Hydromorphone might be as effective as heroin has implications for not just Canada but countries around the word. ... That would affect the treatment of hundreds of thousands of people."
Dr. Brissette said she's awaiting a letter from the ministry confirming the funding cut, which she plans to appeal.
"If you had a new treatment for a disease for a group of people who fail all the treatments ... and the government would say 'No,' how as physicians can we let this pass?"