Consideration of a North American heroin-assisted clinical trial for the treatment of opiate-dependent individuals

Illicit Opioid Use in Canada: Comparing Social, Health, and Drug Use Characteristics of Untreated Users in Five Cities (OPICAN Study)

“…21,45 Reasons for the very limited utilization of existing treatment options may lie in the distinct needs of users as well as in the current structures or practices of treatment programs. 79 However, given the substantial social and health burden from illicit opioid use not effectively reached by treatment as well as the desire expressed for more suitable ("ideal") treatment by many participants, a determined needs-based expansion of treatment options must urgently occur.…”

“…43,44 Despite recent increases in availability, the utilization of MMT is low in Canada overall compared with many other Western countries; only about 25 to 30% of the estimated illicit opioid user population are utilising MMT at any given time. 21,45 Alternative opioid maintenance treatments existing elsewhere-such as buprenorphine, or heroin prescriptionare not currently available as regular treatment options in Canada. 21,46 Given the lack of comparable data on illicit opioid user populations in sites across Canada and the essential importance of such information for needs and evidence-based intervention planning, a multisite cohort study of untreated illicit opioid users in the five cities of Vancouver, Edmonton, Toronto, Montreal, and Quebec City ("OPICAN" study) was established.…”

Heroin-assisted Treatment for drug dependents’ assistance / Los programas experimentales con heroina en la atención de la población drogodependiente

“…La necesidad de nuevas investigaciones y ensayos se manifiesta en varios artículos procedentes de Estados Unidos, Reino Unido, Australia, así como Francia e Italia (Bammer, 1999;Cancrini, 2001;Kuo, Fischer y Vlahov, 2000;Lapeyre-Mestre, 2004;Lawrence, Bammer y Chapman, 2000;Wodak, 2005;Wodal, Ritter y Watson, 2002). Los autores insisten en la adecuación de los estudios a los contextos sociales y políticos concretos de cada país o zona y en la inminencia de la separación político-legal y médica en la investigación con heroína.…”

Screening for antisocial personality disorder in drug users – a qualitative exploratory study on feasibility

“…This nexus is further emphasized by schools of thought that suggest closely related, or even causal, dynamics between those two fields of morbidity -as, for example, proposed by the 'selfmedication' model (Khantzian, 1985). While thorough examination for psychiatric disorders maybe more feasible for in-treatment (especially in-patient) populations, the majority of illicit drug users in North America are not in treatment, are predominantly marginalized, and are difficult to reach for both intervention as well as research purposes (Metzger, Navaline and Woody, 1998;Fischer, Medved, Gliksman and Rehm, 1999;Kuo, Fischer and Vlahov, 2000); and in many instances constitute the so-called 'hidden populations' (Spreen and Zwaagstra, 1994;Kuebler and Hausser, 1997). This poses particular challenges for systematic research with illicit drug user populations focusing on key determinants of morbidity and treatment needs, including psychiatric indicators.…”