Results of world's first study on new treatment for heroin addiction

The results of the ground-breaking SALOME research, published in the JAMA Psychiatry, show chronic heroin addiction now has another effective treatment tool - hyrdomorphone, a licensed pain medication.

"The findings of the SALOME researchers shine a new light on how we can help people with heroin addictions," said Health Minister Terry Lake. "While methadone and suboxone are effective for many people with addictions, there is a proportion of people who have not found success with these treatments. The SALOME study shows there are alternative treatments that may be able to help those who don't respond to methadone and suboxone. This is very exciting research and could go a long way in helping those who need it."

SALOME, which stands for the Study to Assess Longer-term Opioid Medication Effectiveness, found hydromorphone (HDM) to be as effective as diacetylmorphine (pharmaceutical-grade prescription heroin) for people who have not benefited from previous treatments, such as methadone or suboxone.

Led by researchers from Providence Health Care (PHC), the Centre for Health Evaluation and Outcome Sciences (CHÉOS) at St. Paul's Hospital and the School of Population and Public Health of the University of British Columbia (UBC), it's the only clinical trial of its kind in the world.

"Prior to SALOME, hydromorphone had never been evaluated as a substitution treatment for ," said SALOME Principal Investigator Dr. Eugenia Oviedo-Joekes. "Hydromorphone is a widely available licensed . 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."

A total of 202 participants in Vancouver were randomized in a six-month double blind study to receive either injectable hydromorphone or injectable diacetylmorphine (DAM). The medication was administered at PHC's Crosstown Clinic under the supervision of an interdisciplinary team of physicians, nurses, social workers and counselors.

Key findings of the research include:

  • Injectable hydromorphone is as effective as injectable diacetylmorphine for long-term street opioid users not currently benefitting from available treatments (estimated to be about 10 per cent of the opioid-dependent population not currently in treatment).
  • 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.
  • Hydromorphone and diacetylmorphine are both safe when taken in a clinical setting. Out of a total of 88,451 injections, there were 14 overdoses and 11 seizures, all successfully managed in the clinic. If these events had occurred in the street, the outcomes may have been fatal.

"As diacetylmorphine is not presently available in many countries for political and/or regulatory reasons, hydromorphone has a significant advantage as a legal, licensed pain medication," said Dr. Patricia Daly, Vancouver Coastal Health's chief medical health officer. "While methadone and buprenorphine/naloxone are effective heroin addiction treatments for many people and should remain the first line responses, no single treatment is effective for all individuals. Every person with severe opioid use disorder left untreated is at high risk of serious illness and premature death."

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.


Explore further

UBC-Providence Health research to examine new treatments for heroin addiction

More information: JAMA Psychiatry, dx.doi.org/10.1001/jamapsychiatry.2016.0109
Journal information: JAMA Psychiatry

Citation: Results of world's first study on new treatment for heroin addiction (2016, April 6) retrieved 19 June 2019 from https://medicalxpress.com/news/2016-04-results-world-treatment-heroin-addiction.html
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
23 shares

Feedback to editors

User comments

Apr 06, 2016
While decriminalization/legalization is necessary, it needs to be backed up with public health announcements explaining exactly why it is needed. Its not in any way condoning the abuse of addictors, it is done bc the alternative, the drug war, has made things infinitely worse on almost every level, to include making all drugs abundantly available to any & all that wants them. We need to pull LE out of the drug biz & that will free up a lot of resources currently chasing their collective tails. When the laws create more harm and cause more damage than they prevent, its time to change the laws. The $1 TRILLION so-called war on drugs is a massive big government failure - on nearly every single level. Its way past time to put the cartels & black market drug dealers out of business.

Apr 06, 2016
Mass incarceration has failed. We need the science of addiction causation to guide prevention, treatment, recovery & public policies. Otherwise, things will inexorably just continue to worsen & no progress will be made. The war on drugs is an apotheosis of the largest & longest war failure in history. It actually exposes our children to more harm & risk and does not protect them whatsoever. In all actuality, the war on drugs is nothing more than an international projection of a domestic psychosis, it is not the "great child protection act," its actually the complete opposite. We need common sense harm reduction approaches desperately. MAT (medication assisted treatment) and HAT (heroin assisted treatment) must be available options. Of course, MJ should not be a sched drug at all.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more