Does Giving Drugs Of Choice To Addicts Help Or Hinder

I have been struggling with my POV regarding the NAOMI project Results. First of all here is an overview of what I am referring to in case you didn't know... The NAOMI study tested whether heroin-assisted therapy or methadone therapy is better for improving the health and quality of life of long-time opiate users. Eligible participants were randomly assigned to receive a 12-15-month course of medically prescribed injection opioids (heroin or hydromorphone) or oral methadone therapies. Following a slow, but steady recruitment of volunteers who met the study’s rigorous inclusion criteria, NAOMI fully enrolled 251 participants (192 in Vancouver and 59 in Montreal) by March of 2007. The treatment phase of the study was completed in June 2008. Researchers will continue to gather and analyze data until NAOMI’s expected closure date in mid-2009. Funded by the Canadian Institutes of Health Research, and approved by Health Canada, NAOMI enrolled and treated participants in Vancouver and Montreal since 2005. Individuals were considered eligible for the NAOMI study if they: • Had been addicted to heroin, dilaudid or another opiate for five years; • Had been injecting heroin for the past year; • Had tried addiction treatment twice in the past including methadone maintenance; • Were 25 or older; and, • In the case of the Vancouver site, were a member of the Downtown Vancouver community and had been for an extended period of time. Results show that North America’s first heroin therapy study keeps patients in treatment, improves their health and reduces illegal activity. VANCOUVER, BC, October 17, 2008 – Researchers from the North American Opiate Medication Initiative (NAOMI Study) today released final data on the primary outcomes from the three-year randomized controlled clinical trial. “Our data show remarkable retention rates and significant improvements in illicit heroin use, illegal activity and health for participants receiving injection assisted therapy, as well as those assigned to optimized methadone maintenance,” says Dr. Martin Schechter, NAOMI’s Principal Investigator, Center for Health Evaluation and Outcome Sciences and Professor and Director, University of British Columbia School of Population and Public Health. “Prior to NAOMI, all of the study participants had not benefited from repeated standard addiction treatments. Society had basically written them off as impossible to treat.” The data, which was collected from 251 participants at sites in Vancouver and Montreal, demonstrate that a combination of optimized methadone maintenance therapy (MMT) and heroin assisted treatment (HAT) can attract and retain the most difficult-to-reach and the hardest-to-treat individuals who have not been well served by the existing treatment system. Key findings at the 12-month point of the treatment-phase of the study showed that HAT and MMT achieved high retention rates: 88 per cent and 54 per cent respectively. Illicit heroin use fell by almost 70 per cent. The proportion of participants involved in illegal activity fell by almost half from just over 70 per cent to approximately 36 per cent. Similarly, the number of days of illegal activity and the amount spent on drugs both decreased by almost half. In fact, participants once spending on average $1,500 per month on drugs reported spending between $300-$500 per month by the end of the treatment phase. Marked improvements were also seen in participants’ medical status with scores improving by 27 per cent. Of particular note amongst the findings, participants receiving hydromorphone (DilaudidTM) instead of heroin on a double-blind basis (neither they nor the researchers knew) did not distinguish this drug from heroin. Moreover, hydromorphone – an opiate licensed for the relief of pain - appeared to be equally effective as heroin, although the study was not designed to test this conclusively. According to the NAOMI Study Investigators, further research could help to confirm these observations, allowing hydromorphone assisted therapy to be made more widely available. While a comprehensive health economics study is pending, researchers have already determined that the cost of continued treatment is much less than that of relapse. “We now have evidence to show that heroin-assisted therapy is a safe and effective treatment for people with chronic heroin addiction who have not benefited from previous treatments. A combination of optimal therapies – as delivered in the NAOMI clinics - can attract those most severely addicted to heroin, keep them in treatment and more importantly, help to improve their social and medical conditions,” explains Schechter. A summary report of the findings and background information on the study are available at: www.naomistudy.ca. OK, So we have an $8 million study conducted that shows treatment is successful. At first I thought , "Wonderful, another treatment option for addicts." After all, I had always said, Methadone is not for everyone and we only want people to have as many options available as possible. I have supported all forms of treatment including Ibogaine which is a hallucinogenic illegal in the US. Certainly not for me but it has worked for some so I would support it. However, the more I thought about this the more I disagreed with it. Here is why... I was addicted to Oxycontin. I would take other opiates but only if I could not find OC's or couldn't afford them. If someone had come to me before I was in recovery and said, "We are conducting a study to treat your drug addiction which will involve the administration of Oxycontin (or whatever your drug of choice is) at a level to prevent withdrawal. Then we will be studying you to see how you do." I would have jumped at the chance. Don't you think the outcome would have been a decrease or elimination in the amount of money I was spending on the street, a decrease or elimination in any illegal activity I had to commit in order to get money, and an increase in my health due to clean surroundings to inject in, sterile equipment, more money to use for food so I could eat etc? Also, they even remarked that a decrease (Not an elimination) of buying additional drugs off the street as a success. IMO the decrease from $1500/month to between $300-$500/month was because most of the cost was being absorbed by the study. I mean doesn't it make sense that if you spend $1500/month on heroin and then join a study where they GIVE you heroin it may help the cost? OK, now I know someone is going to question how I can have this attitude when I defend the fact that Methadone is not trading drugs. So how can I say this is just keeping them addicted but MMT isn't? Yet, when someone says they are addicted to Methadone I have never heard anyone tell them to go to a Methadone clinic! In the case of MMT patients we are not being treated with our drug of choice. Does that make any sense? So, while I am all for clean needle exchanges, even clean injection sites I believe those programs come with a responsibility to educate and offer treatment (of their choice) to anyone using these programs. I still believe a variety of programs need to be available because what works for one won't work for all but the programs shouldn't offer drugs of choice as treatment either. I would like to know what others think about this including other addicts.