“We need every tool in the toolkit available.” More treatment options for heroin addiction

Yesterday the results from the SALOME study were published, and the groundbreaking findings are tremendously exciting.

The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) was a Vancouver-based clinical study testing alternative treatments for those with chronic heroin addiction. It compared injectable hydromorphone to injectable diacetylmorphine (heroin-assisted treatment in the form of pharmaceutical heroin) for long-term street opioid users not currently benefitting from available treatments, such as methadone and suboxone. Previous research in Canada and internationally has already demonstrated the effectiveness of heroin-assisted treatment.

The SALOME study demonstrates that hydromorphone is as effective as diacetylmorphine. This is incredible news. Hydromorphone works. Heroin-assisted treatment works. The results mean that doctors, and their patients, have another potential treatment option available to them.

The small group of Canadian patients who received, and continue to receive, these medicines -- all of whom took part in the clinical trial -- report substantial improvement to their health and well-being. Receiving the treatment in a supervised, medical setting improved physical and mental-health outcomes. It reduced illicit drug use and related criminal activity since they no longer need to rely on street-grade heroin. It stabilized their lives, many finding housing and employment when previously both had been impossible.

While both have been proven effective, the difference in accessing heroin-assisted treatment and hydromorphone is this: whereas hydromorphone is already federally approved as a painkiller, access to diacetylmorphine faces political and regulatory obstacles. These obstacles need to be removed, and, with a record number of fentanyl-related overdose deaths among opiate users in the last two years, they need to be removed as soon as possible.

In October 2013, then-Health Minister Rona Ambrose added diacetylmorphine to the list of restricted substances available through Health Canada’s Special Access Program (SAP). SAP is designed to let patients get medications normally not available in Canada on the basis of credible data supporting the safety and efficacy of the drug for the medical emergency at issue. It’s the same program that allows supervised injection facilities like Insite to operate.

The decision by the Health Minister effectively cut-off access to diacetylmorphine to participants in the SALOME trial via the SAP program. Only a court injunction obtained by Pivot, representing five participants, and Providence Health Care, who led the study, has allowed study participants to continue to access the treatment now that the study has ended. It is, to say the least, an unnecessarily onerous and convoluted process for doctors to access a treatment that has been proven time and time again to work.

But injunctions are only temporary, and unless the new federal government reverses the previous Health Minister’s decision the ability for patients and doctors to access this incredibly important treatment may yet again be put at risk.

There’s no need for the new federal government to allow their predecessor’s ideologically fuelled decision to stand, especially in light of the many positive steps they’ve already taken to improve access to life-saving treatment interventions.

The SALOME results highlight that the solutions to this health crisis are readily available. It’s time now for the federal government to remove restrictions and make all effective addiction treatments available to doctors and patients. 

As Dr. Scott MacDonald, physician lead at Vancouver’s Crosstown Clinic, the only clinic where both hydromorphone and heroin-assisted treatment are available, said yesterday at the study results announcement: “We need every tool in the addiction treatment toolkit available.”