The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

Abstract

Standardized assessment instruments such as the European Addiction Severity Index and the Maudsley Addiction Profile were employed. A total of 251 individuals were randomized from Vancouver, BC (192, 76.5%), and Montreal, Quebec (59, 23.5%); 38.5% were female, the mean age was 39.7 years (SD:8.6), and participants had injected drugs for 16.5 years (SD:9.9), on average. In the prior month, heroin was used a mean of 26.5 days (SD:7.4) and cocaine 16 days (SD;12.6). Vancouver had significantly more patients residing in unstable housing (88.5 vs. 22%; pG0.001) and higher use of smoked crack cocaine (16.9 days vs. 2.3 days in the prior month; pG0.001), while a significantly higher proportion of Montreal participants reported needle sharing in the prior 6 months (25% vs. 3.7%; pG0.001). In many respects, the patient cohort was similar to the European trials; however, NAOMI had a higher proportion of female participants and participants residing in unstable housing. This study suggests that the NAOMI study successfully recruited participants with a profile indicated for HAT. It also raises concern about the high levels of crack cocaine use and social marginalization.

Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment

“…Detailed inclusion and exclusion criteria and baseline characteristics of the study participants have been published previously. 23,28 In brief, at baseline, the study participants were 25 years or older, with regular opioid injection, a minimum five-year history of opioid use, and at least two previous attempts at substitution treatment for opioid dependence. The average age of the participants was 39.7 years, and 61.4% were men.…”

Reduction in Acquisitive Crime During a Heroin-Assisted Treatment: a Post-Hoc Study

“…Compared to participants in other trials [13,14,[16][17][18][19]22], our participants showed the same level of criminal involvement in the past but were less involved in illegal activities at baseline (Table 3). The main crimes committed by our population were acquisitive crime.…”

Commentary on Metrebian et al (2015): What is addiction treatment research about? Some comments on the secondary outcomes of the Randomized Injectable Opioid Treatment Trial

“…The German trial had an entry criterion of 'poor physical and/or mental health with at least 13 symptoms on the Opiate Treatment Index OTI' [9], and the Dutch trials had an entry criterion of 'poor physical or mental health', including those not stabilized on psychiatric medication [10], while in RIOTT any 'active significant medical or psychiatric condition' was excluded [11]. Participants were recruited from methadone programmes [1,10], but also from the street being out of treatment [9,12,13]. The following instruments for initial assessments were used: DSM-IV [10], Symptom Checklist Index-90 (SCL-90) [10], SCL-90-R [9], Opiate Treatment Index (OTI) [9,12], Short Form (SF)-12 [12], Addiction Severity Index (ASI) [12], Europ-ASI [13] and the SF Health Survey [14], plus diverse laboratory data.…”

“…Participants were recruited from methadone programmes [1,10], but also from the street being out of treatment [9,12,13]. The following instruments for initial assessments were used: DSM-IV [10], Symptom Checklist Index-90 (SCL-90) [10], SCL-90-R [9], Opiate Treatment Index (OTI) [9,12], Short Form (SF)-12 [12], Addiction Severity Index (ASI) [12], Europ-ASI [13] and the SF Health Survey [14], plus diverse laboratory data. Outcome measurements and responder definition varied across trials ( [15], p. 38), and differences in treatment regimens were substantial with regard to dosages ([15], p. 39).…”