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Injectable hydromorphone now approved to treat opioid addiction

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Health Canada recently announced that it has approved the use of injectable hydromorphone (HDM) for the treatment of severe opioid use disorder across the country. This means that many of the regulatory and logistic challenges previously faced by healthcare practitioners in procuring effective alternative treatments for their patients will be removed.

In her announcement, Ginette Petitpas Taylor, Minister of Health, stated that the evidence clearly demonstrates that this medication is a valuable treatment option for opioid use disorder, improving health and retention in care for those who have not benefitted from existing treatments.

This decision, and the evidence cited in the announcement, is a direct result of the work by CHÉOS and PHC scientists and staff in the Study to Assess Longer-Term Opioid Maintenance Effectiveness (SALOME) Trial, led by Dr. Eugenia Oviedo-Joekes.

The SALOME Trial was a three-year, double-blinded trial which demonstrated that HDM (trademarked as Dilaudid) is as effective as diacetylmorphine (pharmaceutical-grade heroin) at treating long-term, chronic opioid dependence.

Later cost-effectiveness analyses of SALOME, led by Dr. Nick Bansback, showed that, compared to methadone alone, injectable treatments increase quality of life and save cost overall, mostly through reduction in street crime and hospitalizations. Over a lifetime, the provision of hydromorphone could save society $140,000 per individual, with most savings occurring through reductions in the involvement in property and violent crime.

Ultimately, the SALOME Trial concluded that HDM was an effective, safe treatment for opioid use disorder that could be offered as an alternative to other treatments.

“Our research was able to demonstrate that this treatment is safe, that it works, and that it can save lives and money,” said Dr. Oviedo-Joekes “This announcement from Health Canada is an encouraging example of research evidence informing policy decisions that will have tangible impacts across the country.”

Minister Petitpas Taylor has also announced that diacetylmorphine has been added to the List of Drugs for an Urgent Public Health Need, meaning all provinces and territories are now able to import the drug for treatment of opioid use disorder.

The North American Opiate Medication Initiative (NAOMI), a previous study, co-led by Dr. Oviedo-Joekes  found that diacetylmorphine (heroin) assisted treatment was a safe and effective treatment for improving the health and quality of life of long-time opioid users who had not previously benefitted from methadone ore other treatment options.

“Increased access to a safe supply of prescription opioids is an innovative tool that will help save lives” says Health Minister Ginette Petitpas Taylor. According to Health Canada, 10,337 people have died from fatal overdoses between January 2016 and September 2018.