Junkies Get Free, Clean Heroin Alternative in Vancouver Trial

By Tony O'Neill 10/18/11


Vancouver's Famed "Heroin Alley." photo via

Just days after Canada’s Supreme Court smacked down the ruling Conservative party’s attempts to close Insite, the cutting-edge walk-in safe-injecting clinic in Vancouver, comes the latest volley from harm-reduction advocates north of the border. Over the next three years a new trial will test whether giving heroin addicts access to free, clean opiates can be an effective way to stabilize hardcore users and ultimately entice them into drug treatment.

SALOME (Study to Assess Longer-term Opiate Maintenance Effectiveness) grew out of the earlier NAOMI (North American Opiate Maintenance Initiative) study. whose conclusions were similar to those of similar trials in Switzerland, Germany and other highly evolved nations: “Heroin-assisted therapy proved to be a safe and highly effective treatment for people with chronic, treatment-refractory heroin addiction. Marked improvements were observed including decreased use of illicit “street” heroin, decreased criminal activity, decreased money spent on drugs, and improved physical and psychological health,” as NAOMI's authors wrote.

Unlike the earlier trial, the focus of SALOME is not on heroin prescribing. With the Conservative government's panties already in a bunch over injecting rooms, a less controversial alternative to handing out heroin had to be foundt. The solution?  Hydromorphone (trade name Dilaudid), a legally available painkiller whose effects are almost indistinguishable from heroin—not a surprise given that it is synthesized from morphine. “There’s less of a stigma, less of an aura, around hydromorphone, and it’s legally available,” said British Columbia’s medical health officer, Perry Kendall. “In Switzerland and Germany, they don’t have a problem with treating people with heroin, but here we do.”

While it’s certainly cheering to see such progressive measures north of the border, it’s also a little amusing to see the two-step taking place around the heroin vs. hydromorphone issue, as if somehow one drug is “better” because it’s legal. As any junkie worth his salt should know (and I can definitely personally attest, a shot of Dilauded is actually preferable to a hit of street heroin. Indeed, anyone who has read the novel (or seen Gus Van Sant's screen adaptation of) Drugstore Cowboy might remember Bob Hughes’ many soliloquies on the wonders of Dilauded.  

Still, if that's what it takes to get the Canadian government onboard, I’m sure the Vancouver addicts eagerly enrolling in the trial won't argue… And as for our supposedly “progressive” president and his "evidence-based reforms" of drug research and policy?  (Crickets.)

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Tony O'Neill, a regular contributor to The Fix, is the author of several novels, including Digging the VeinDown and Out on Murder Mile and Sick City. He also co-authored the New York Times bestseller Hero of the Underground (with Jason Peter) and the Los Angeles Times bestseller Neon Angel (with Cherie Currie). He lives in New York with his wife and daughter. You can follow Tony on Twitter.