MSFHR-funded research highlights new treatment for heroin addiction

20 April 2016

Chronic heroin addiction now has another effective treatment tool – hydromorphone, a licensed pain medication – according to 2011 MSFHR Scholar Dr. Eugenia Oviedo-Joekes and her colleagues at Providence Health Care, the Centre for Health Evaluation and Outcome Sciences (CHÉOS) and the UBC School of Population and Public Health.

Dr. Oviedo-Joekes is the principal investigator of a four-year project called Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), the largest clinical trial of its kind in the world. She and her colleagues recruited a total of 202 participants in Vancouver who were randomized in a six-month double-blind study to receive either injectable hydromorphone or injectable diacetylmorphine (pharmaceutical-grade prescription heroin). The medication was administered at Providence Health Care’s Crosstown Clinic under the supervision of a team of physicians, nurses, social workers, and counselors.

The results, published in the journal JAMA Psychiatry earlier this month, show hydromorphone to be as effective as diacetylmorphine for people who have not benefited from previous treatments, such as methadone or suboxone.

“Prior to SALOME, hydromorphone had never been evaluated as a substitution treatment for opioid dependence,” said Dr. Oviedo-Joekes. “Hydromorphone is a widely available licensed pain medication. Our study shows that hydromorphone is as effective as diacetylmorphine, providing a licensed alternative to treat severe opioid use disorder. Providing injectable opioids in specialized clinics under supervision ensures safety of both the patients and the community, and the provision of comprehensive care.”

Other key findings of the research include:

  • Study participants on both medications reported far fewer days of street-heroin and other opioid use at six months (three to five days per month), compared to almost daily illicit opioid use prior to being enrolled in the study.
  • Participants also reported a significant reduction in days of illegal activities (from an average of 14.1 days per month to less than four).
  • Almost 80% were retained in treatment at six months.

SALOME started in late 2011 and concluded in late 2015. It is the follow-up study to the North American Opiate Medication Initiative (NAOMI), North America’s first-ever clinical trial of diacetylmorphine/prescription heroin as an opioid agonist treatment medication.