Telling our stories: heroin-assisted treatment and SNAP activism in the Downtown Eastside of Vancouver

Abstract

BackgroundThis article highlights the experiences of a peer-run group, SALOME/NAOMI Association of Patients (SNAP), that meets weekly in the Downtown Eastside of Vancouver, British Columbia, Canada. SNAP is a unique independent peer- run drug user group that formed in 2011 following Canada’s first heroin-assisted treatment trial (HAT), North America Opiate Medication Initiative (NAOMI). SNAP’s members are now made up of former research participants who participated in two heroin-assisted trials in Vancouver. This article highlights SNAP members’ experiences as research subjects in Canada’s second clinical trial conducted in Vancouver, Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), that began recruitment of research participants in 2011.MethodsThis paper draws on one brainstorming session, three focus groups, and field notes, with the SALOME/NAOMI Association of Patients (SNAP) in late 2013 about their experiences as research subjects in Canada’s second clinical trial, SALOME in the DTES of Vancouver, and fieldwork from a 6-year period (March 2011 to February 2017) with SNAP members. SNAP’s research draws on research principles developed by drug user groups and critical methodological frameworks on community-based research for social justice.ResultsThe results illuminate how participating in the SALOME clinical trial impacted the lives of SNAP members. In addition, the findings reveal how SNAP member’s advocacy for HAT impacts the group in positive ways. Seven major themes emerged from the analysis of the brainstorming and focus groups: life prior to SALOME, the clinic setting and routine, stability, 6-month transition, support, exiting the trial and ethics, and collective action, including their participation in a constitutional challenge in the Supreme Court of BC to continue receiving HAT once the SALOME trial ended.ConclusionsHAT benefits SNAP members. They argue that permanent HAT programs should be established in Canada because they are an effective harm reduction initiative, one that also reduces opioid overdose deaths.

Heroin-Assisted Treatment and Supervised Drug Consumption Sites: Experience from Four Countries

“…The origins of HAT in Canada date back to a sequence of clinical trials, which started in the mid-2000s (Boyd et al 2014). A trial (called the North American Opiate Medication Initiative, NAOMI) was established in the Crosstown clinic in Vancouver and in Montreal, running from 2005Montreal, running from -2008 From 2011-2014, the NAOMI trial was followed at Crosstown by the SALOME (Study to Assess Longer-term Opioid Medication Effectiveness) trial, which compared the effectiveness of diamorphine (another term for heroin; diacetylmorphine is also sometimes used) and hydromorphone provision.…”

Injectable opioid agonist treatment for opioid use disorder: a national clinical guideline

“…10,11 Meta-analyses have shown that, among individuals who are refractory to treatment with methadone, supervised injectable diacetylmorphine is beneficial in terms of reducing illicit opioid use, premature treatment discontinuation (or "treatment dropout"), criminal activity, incarceration and mortality, as well as improving overall health and social functioning, quality of life and stability. [12][13][14][15][16][17] In response to regulatory barriers limiting the provision of diacetylmorphine for the treatment of opioid use disorder in Canada, the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) trial compared injectable hydromorphone to injectable diacetylmorphine and found that both medications, delivered in identical conditions, showed positive outcomes such as high retention rates and reduction of street opioid use (from daily to a few days per month) and illegal activities. 14 Thus, in jurisdictions where diacetylmorphine is currently not available, or for patients in whom it is contraindicated or unsuccessful, hydromorphone may provide an effective, licensed alternative.…”

Considering Heroin-Assisted Treatment and Supervised Drug Consumption Sites in the United States

“…The origins of HAT in Canada date back to a sequence of clinical trials, which started in the mid-2000s (Boyd, Murray, and MacPherson, 2017). A trial (called the North American Opiate Medication Initiative [NAOMI]) was established in the Crosstown clinic in Vancouver and in Montreal, running from 2005 to 2008.…”