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Randomized Controlled Trial
. 2010 May-Jun;101(3):210-2.
doi: 10.1007/BF03404375.

Characteristics and response to treatment among Aboriginal people receiving heroin-assisted treatment

Eugenia Oviedo-Joekes  1 , Daphne Guh, David C Marsh, Suzanne Brissette, Bohdan Nosyk, Michael Krausz, Aslam Anis, Wayne M Christian, Patricia Spittal, Martin T Schechter
Affiliations
Randomized Controlled Trial

Characteristics and response to treatment among Aboriginal people receiving heroin-assisted treatment

Eugenia Oviedo-Joekes et al. Can J Public Health. 2010 May-Jun.

Abstract
in English, French

Background: Medically prescribed diacetylmorphine, the active ingredient of heroin, has been shown to be effective for the treatment of severe opioid addiction. However, there are no data regarding its effectiveness among Aboriginal heroin injectors.

Methods: The present analyses were performed using data from the NAOMI study (North American Opiate Maintenance Initiative), an open-label randomized controlled trial that compared the effectiveness of injectable diacetylmorphine (45.8%) and hydromorphone (10%) vs. oral methadone (44.2%) among long-term treatment-refractory opioid-dependent individuals. Rates of retention and response to treatment were analyzed among participants from the Vancouver site (n = 192).

Results: Baseline profiles were similar among Aboriginal (n = 60) and non-Aboriginal (n = 132) participants except for higher HIV positive rates among Aboriginal people (23.3% vs. 8.3%). Among Aboriginal participants in the injection and methadone groups, retention rates at 12 months were 84.4% vs. 57.1% and response rates were 68.8% vs. 53.4%, respectively. Aboriginal and non-Aboriginal rates were not significantly different.

Discussion: Offering treatment assisted with medically prescribed diacetylmorphine or hydromorphone to long-term treatment-refractory opioid-dependent Aboriginal people could be an effective way to attract them into and retain them in treatment as well as dramatically reduce the risk of HIV infection.

Contexte: Prescrite à des fins médicales, la diacétylmorphine, ingrédient actif de l’héroïne, a prouvé son efficacité dans le traitement de la dépendance sévère aux opiacés. Cependant, il n’existe pas de données sur son efficacité chez les héroïnomanes autochtones.

Méthode: Nos analyses ont été effectuées à l’aide des données de l’étude NAOMI (North American Opiate Maintenance Initiative), un essai ouvert randomisé et contrôlé qui compare l’efficacité de la diacétylmorphine injectable (45,8 %) et de l’hydromorphone (10 %) au traitement oral à la méthadone (44,2 %) chez les opiomanes réfractaires aux traitements prolongés. Nous avons analysé les taux de maintien et de réponse au traitement chez les participants de l’étude à Vancouver (n=192).

Résultats: Les profils de référence des participants autochtones (n=60) et non autochtones (n=132) étaient semblables, à l’exception du taux de séropositivité VIH, plus élevé chez les Autochtones (23,3 % c. 8,3 %). Parmi les participants autochtones des groupes du traitement par injection et du traitement à la méthadone, les taux de maintien après 12 mois étaient de 84,4 % et de 57,1 %, et les taux de réponse étaient de 68,8 % et de 53,4 %, respectivement. Les taux pour les Autochtones n’étaient pas significativement différents des taux pour les Non-Autochtones.

Discussion: Offrir aux opiomanes autochtones réfractaires aux traitements prolongés un traitement assisté par la diacétylmorphine prescrite à des fins médicales ou par l’hydromorphone pourrait être un moyen efficace de les attirer vers les centres de traitement et de réduire considérablement leurs risques de contracter des infections à VIH.

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