History of Treatment Access and Drug Use among Participants in a Trial Testing Injectable Opioids under Supervision for Long-Term Heroin Injectors - Abstract
Background: For opioid-dependent patients not benefitting from conventional treatments (i.e., oral methadone), evidence suggests that supervised injectable medications are effective. The present study aims to describe participants’ baseline characteristics in a study comparing injectable diacetylmorphine and hydromorphone and factors independently associated with prior access to methadone at high doses.
Methods: SALOME (Study to Assess Longer-term Opioid Medication Effectiveness) is a phase III, randomized, double blind controlled trial comparing injectable diacetylmorphine and hydromorphone in 202 chronic, opioid-dependent, current injection opioid users in Vancouver who had at least one prior episode of opioid maintenance treatment (OMT). Measures included questionnaires and drug dispensation records. In addition to descriptive statistics, multivariable logistic regression was used to determine characteristics associated with reaching a stable weekly average methadone dose of 100 mgs daily or more during a methadone treatment episode.
Results: Participants had a mean of fifteen years of illicit opioid use, several OMT attempts, medical problems, criminal justice histories, unstable housing, daily use of illicit opioids and regular use of cocaine. Multivariable analysis showed that individual characteristics, such as separation from biological parents, prior prescription of opioids for pain and other medical conditions, and preferred methadone dose were independently associated with prior methadone episodes that reached 100 mgs.
Conclusions: These data emphasize that study participants were in need of alternative treatments at the time of enrolment and fit the profile of patients to whom supervised injectable treatment should be offered. Adding specific dose and duration requirements with respect to prior OMT might exclude individuals who would benefit significantly from injectable treatment.