06 Apr Injectable Hydromorphone May Be An Alternative Treatment For Chronic Heroin Addiction
MedicalResearch.com Interview with:
Dr. Eugenia Oviedo-Joekes PhD
Assistant Professor, School of Population and Public Health
University British Columbia
Centre for Health Evaluation and Outcome Sciences
Providence Health Care, St Paul’s Hospital, Vancouver
British Columbia, Canada
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Oviedo-Joekes: Diacetylmorphine is the active ingredient in heroin. Medically prescribed diacetylmorphine has shown greater effectiveness than methadone alone for the treatment of patients with long term opioid dependence who are not benefitting from available treatments (i.e., they continue injecting in the street daily for many years). Medically prescribed diacetylmorphine is being used in a small number of countries in Europe but is unlikely to be accepted in many countries around the world, including Canada and the US. SALOME is the world’s first study to examine the effectiveness of hydromorphone, a licensed, legal pain medication, as an alternative treatment to diacetylmorphine for chronic heroin addiction.
Participants were randomly assigned to receive injectable diacetylmorphine or hydromorphone, double-blinded (up to three times daily) for six months under supervision. Injectable hydromorphone was as effective as injectable diacetylmorphine for long-term street opioid users not currently benefitting from available treatments (about 10 per cent of the heroin-dependent population).Study participants on both medications reported far fewer days of street-heroin and other opioid use at six months compared to almost daily illicit opioid use before taking part in the study. They also reported a reduction in days of illegal activities, from an average of 14.1 days per month to fewer than four.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Oviedo-Joekes: Providing injectable opioids in specialized clinics under supervision ensures safety of both the patients (e.g., they can treat overdoses) and the community (e.g., it’s a drug diversion), and the provision of comprehensive care many or our patients need after decades of street opioid use.
People should take away the fact that we now have another tool in the toolkit – another treatment option for chronic, heroin-dependent persons who have not responded sufficiently well to standard treatments. This group represents about 10% of the heroin-dependent population. Because the results are positive, we can now pursue the licensing of hydromorphone as a substitute treatment for heroin dependency. That adds another option for physicians and patients alongside existing medications like methadone and Suboxone. As a shorter-term solution, hydromorphone, currently a legal analgesic, could be prescribed off-label as a heroin-substitute treatment.
A significant takeaway is that clinicians and patients should begin to recognize that heroin dependence is a chronic illness, like diabetes or heart disease, and can be managed with regular treatment. We now have another treatment option to treat this chronic illness – hydromorphone.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Oviedo-Joekes: Addiction research must move away from the stigma attached to certain medications and explore alternative treatments to attract and retain patients into care. New treatment approaches should account for overall patients’ needs and provide patient-centered care for this chronic condition. There is no single answer for treating drug dependency; thus we need to continue to meet patients where they are at..
MedicalResearch.com: Is there anything else you would like to add?
Dr. Oviedo-Joekes: Currently there are between 60,000 and 90,000 people in Canada suffering from chronic heroin dependence. This costs society a great deal, about $45,000 per individual each year in terms of related medical, public health, policing, criminal justice and jail expenses, along with crimes against people and property. In terms of the human cost, every person with severe opioid use disorder left untreated is at high risk of serious illness and premature death. Any additional treatment option has the potential to go a long way in reducing these costs.
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Oviedo-Joekes E, Guh D, Brissette S, et al. Hydromorphone Compared With Diacetylmorphine for Long-term Opioid Dependence: A Randomized Clinical Trial.JAMA Psychiatry. Published online April 06, 2016. doi:10.1001/jamapsychiatry.2016.0109.
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Dr. Eugenia Oviedo-Joekes (2016). Injectable Hydromorphone May Be An Alternative Treatment For Chronic Heroin Addiction MedicalResearch.com