Home > All Posts > Supervised Injections Help Heroin Addicts Who Can’t Use Methadone

Supervised Injections Help Heroin Addicts Who Can’t Use Methadone


By Martin Schechter, The Province

November, 26, 2008      A recent column by Dr. Stanley DeVlaming was a critical of a Canadian study of injectable heroin for addicts known as the North American Opiate Medication Initiative (NAOMI).

Regrettably, DeVlaming’s comments reflect a fundamental misunderstanding of clinical research, and of the NAOMI trial, specifically.

DeVlaming suggested the NAOMI participants could not be relied upon for follow-up participation or for truthfulness. In fact, more than 95% of NAOMI patients completed follow-up, a rate as high, if not higher, than one would see in studies of cancer or heart disease.

Also, in the group receiving hydromorphone who self-reported no use of street heroin after 12 months, 100% were proven truthful by urine testing.

To blindly accuse people with severe heroin addiction of being universally unreliable and untruthful is to perpetuate the stigma attached to this marginalized group.

DeVlaming suggested we couldn’t find enough patients who had truly failed the established treatment, methadone. Wrong again.

While one previously attempt at methadone was the minimum to be eligible for NAOMI, in fact. the average was three attempts.

Not only had our participants tried methadone, but they had tried it over and over again.

DeVlaming suggested that the lowered sample size during the NAOMI trial means that the results are less informative. Not so. The target sample size was reduced from 470 to 250 when the differences between he groups turned out to be much larger than originally expected.

This reduction received prior approval by an independent safety board, two ethics committees and Health Canada.

It is unethical to enroll more patients in a clinical trial when a smaller number suffices to reach valid scientific conclusions. NAOMI’s results were highly significant from both a statistical and clinical perspective with 251 participants instead of 470.

DeVlaming’s comments about the safety of this treatment also are ill founded.

The majority of medication-related adverse events were expected “pins and needles” sensations that participants considered nothing more than a nuisance.

Interestingly, DeVlaming did not comment that in over 110,000 injection episodes in NAOMI, there were a mere 13 episodes of overdose requiring attention (about 1.2 per 10,000)all of which were treated easily. With street drugs, overdose rates are at least 10 times higher.

The NAOMI results support the wider availability of improved evidence-based methadone treatment.

But not all heroin user are attracted into or benefit from this.

For those heroin users who are not effectively treated with methadone, the controlled injection of pharmaceutical grade medication under the supervision of doctors and nurses is much safer than continued injection of illegal heroin on the street.

Dr. Martin Schechter of University Of British Columbia is the principal investigator for the North American Opiate Medication Initiative.

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