United Press International - October 5, 2002
Michael Smith

A proposal should go the Canadian health ministry within a week, Vancouver physician Martin Schechter, of the University of British Columbia, told United Press International.

Similar studies have been carried out in Europe, where using heroin in treatment programs has been tried in several countries, Schechter said, but this would be the first in North America.

The standard addiction therapy, in which addicts are given methadone, a heroin substitute, "can be highly effective," Schechter earlier told the first International Conference on Inner City Health. However, many addicts either refuse to try methadone, which is taken orally, or do not stick with it long enough to kick their habit.

The study would enroll nearly 500 addicts in several Canadian cities, Schechter said, and they would be assigned randomly to receive either a heroin-based treatment program or the standard methadone therapy.

If it is approved, the study would begin enrolling patients next year, Schechter said, adding the European experience seems to show that such programs give addicts the stability to decide to get off drugs and access to programs that can help them when they do.

"Everyone comes to a magic moment when they're ready to move on," Schechter said. "We want to be there when that happens."

Even before addicts decide to get off drugs, he said, the European studies have shown that heroin-based therapy, using standard doses of pharmaceutical-grade heroin, reduces drug-related crime, improves the health of addicts and helps them to hold jobs.

In cities like Vancouver, where HIV and hepatitis C are spreading rapidly among drug users, a treatment program using heroin, in a controlled setting, might prevent more addicts from being infected, Schechter said.

In Europe, the heroin therapy "acted as a lure" to get addicts off the streets, away from a drug culture, and into contact with the health-care system, said epidemiologist David Vlahov, of the New York Academy of Medicine.

Vlahov was among a group of American researchers who had hoped to carry out a similar study in the United States and had gone so far as to get the study's design approved by the National Institutes of Health, as well as two ethical committees and a group of addicts.

The idea foundered, Vlahov said, when doctors refused to sign on to the controversial plan. "The issue in the U.S. has been the reluctance of clinicians to move forward," Vlahov said.

The proposed study likely will be controversial even in Canada, said Toronto physician Phillip Berger, a nationally known expert on treating HIV and AIDS.

"Even raising the possibility of heroin treatment will throw many politicians -- especially those on the right -- into absolute apoplexy," Berger told the conference.

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