2015 APHA Annual Meeting & Expo

Home Events & Meetings Annual Meeting Schedule & Program

Recorded Annual Meeting Presentations (RAMP) are now available for purchase.
Only $90 for presenters, $140 for registered attendees and $200 for non-attendees.

Online Program

329271
Characteristics and response to treatment among Aboriginal people receiving treatment with injectable opioids for the treatment of long-term opioid-dependency


Sunday, November 1, 2015

Eugenia Oviedo-Joekes, PhD, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Heather Palis, PhD Candidate, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Kirsten Marchand, PhD Candidate, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Daphne Guh, MSc, Centre for Health Evaluation and Outcome Sciences, BC, Canada
Scott MacDonald, MD, Providence Health Care, Crosstown Clinic, Vancouver BC, BC, Canada
Scott Harrison, MA, School of Nursing, University of British Columbia, Vancouver, BC, Canada
Suzanne Brissette, MD, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, QC, Canada
David Marsh, MD, Northern Ontario School of Medicine, Sudbury, ON, Canada
Martin T Schechter, OBC MD PhD FRSC FCAHS, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
background:

Studies in Europe and Canada have demonstrated that injectable diacetylmorphine (the active ingredient on heroin), provided in specialized clinics, is effective at engaging and retaining the most vulnerable street heroin injectors in treatment. Due to the political restrictions around diacetylmorphine, other alternatives are needed.  Such an alternative could be injectable hydromorphone (a licensed pain medication).  Since women and Aboriginal people face structural inequalities that add to their problematic drug use and could affect treatment outcomes, we aim to test the effectiveness of hydromorphone among them and uncover possible explanatory factors. 

methods:

We analyze data from a randomized double-blind controlled trial (Vancouver, Canada), testing if injectable hydromorphone is non-inferior to diacetylmorphine for treatment-resistant long-term opioid-dependency over six months.  Main results of the parent study will be published in April-May 2015. For this secondary analysis we will test non-inferiority by gender and ethnicity, by examining the 90% confidence interval, one sided α=.05, around the difference between hydromorphone and diacetylmorphine, for an effect size of 0.80, in the number of days of illicit heroin use in the prior month.

preliminary results:

A total of 202 individuals were randomized, 62 (30.7%) women, 62 (30.7%) Aboriginal. Preliminary analyses indicate that hydromorphone is non-inferior to diacetylmorphine for women and aboriginal people.  Aboriginal people showed significantly less days of street heroin use compared to non-aboriginal.   

conclusion:

Among women and Aboriginal people not reached by other treatments, injectable hydromorphone in supervised clinics is as effective as diacetylmorphine. Aboriginal people showed more improvements than non-aboriginals.

Learning Areas:

Public health or related research

Learning Objectives:
Assess the effectiveness of treatment with injectable hydromorphone in supervised clinics for women and Aboriginal people.

Keyword(s): Clinical Trials, Underserved Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. MacDonald is the physician lead at the Providence Crosstown Clinic which was the site of SALOME. He continues to supervise injectable opiate/opioid assisted substitution treatment (iOAT) at the clinic. Dr. MacDonald and his team are the first physicians in the world to prescribe hydromorphone for the treatment of substance use disorder.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 2057.0: International perspectives on substance use and health outcomes