Hyrdomorphone shows efficacy for heroin addiction treatment

by Bruce Sylvester: Hyrdomorphone, a licensed pain medication, shows efficacy in treating chronic heroin addiction, researchers from the SALOME (the Study to Assess Longer-term Opioid Medication Effectiveness) trial reported on April 6, 2016 in JAMA Psychiatry.

“Prior to SALOME, hydromorphone had never been evaluated as a substitution treatment for opioid dependence,” said lead investigator Eugenia Oviedo-Joekes, PhD, assistant professor in the University of British Columbia School of Population and Public Health, Vancouver, British Columbia. “Hydromorphone is a widely available licensed pain medication. Our study shows that hydromorphone is as effective as diacetylmorphine [pharmaceutical-grade prescription heroin], providing a licensed alternative to treat severe opioid use disorder. Providing injectable opioids in specialized clinics under supervision ensures safety of both the patients and the community, and the provision of comprehensive care,” she added.

In the six-month, double blind study, the investigators randomized 202 subjects in Vancouver to receive injections of either hydromorphone or diacetylmorphine, 100 to hydromorphone and 102 to diacetylmorphine.

Mean age was 44 years, and 62 of the subjects were women.

The injections were administered in a clinic in Vancouver, and under the supervision of an interdisciplinary team of physicians, nurses, social workers and counselors.

Primary efficacy outcome was change in days of use of street heroin.

Eighty percent of the subjects completed the study.

The researchers reported that injectable hydromorphone was as effective as injectable diacetylmorphine.

Daily illicit opioid use in both cohorts at six months, which ranged from three to five days per month, was down from almost daily illicit opioid use prior to being enrolled in the study.

Following the 88,451 study-related injections, there were 14 overdoses and 11 seizures. They were all managed in the clinic and with no fatalities.

“As diacetylmorphine is not presently available in many countries for political and/or regulatory reasons, hydromorphone has a significant advantage as a legal, licensed pain medication,” said Patricia Daly, MD, chief medical health officer at Vancouver Coastal Health.

British Columbia’s Minister of Health, Terry Lake, added, “The findings of the SALOME researchers shine a new light on how we can help people with heroin addictions. While methadone and suboxone are effective for many people with opioid addictions, there is a proportion of people who have not found success with these treatments. The SALOME study shows there are alternative treatments that may be able to help those who don’t respond to methadone and suboxone. This is very exciting research and could go a long way in helping those who need it.”