HEROIN STUDY STRUGGLES FOR TEST SUBJECTS

[Cure20]

VANCOUVER, British Columbia - On Vancouver's skid row, one of the most heroin-addicted neighborhoods in Canada, researchers offering a free prescription version of the drug have been struggling to find test subjects.

North America's leading study of whether a therapy using prescription heroin can help treat chronic addicts was launched in February and Canadian researchers had planned to enroll 470 addicts within six to nine months.

The researchers working in Vancouver and Montreal have only enrolled 80 people, and their hope of conducting part of the government-sponsored C$8.1 million study in Toronto has failed to work out.

"Initially, recruitment was slower than expected," said Dr. Martin Schechter, who heads the North American Opiate Medication Initiative ( NAOMI ). "We're working very hard to get as many people as we can."

The study received international attention when it began, with critics in Canada and the United States attacking the idea as coddling addicts.

Researchers say many addicts who wanted to participate were turned down because they did not pass the rigorous screening.

Participants must have been addicted to heroin or other opiates for at least five years. They must also have tried and failed more than once in rehabilitation programs using the drug methadone.

The study is examining if hard-core addicts will be more willing to stick with a prescribed heroin treatment program than the traditional methadone treatment.

Researchers also worry their recruitment was initially too passive and relied on addicts to come to them. They have now gone into the community to seek participants through health and support groups.

Diane Tobin, a Vancouver resident who has struggled with heroin addiction for 30 years, was finally accepted into the study two weeks ago.

She said she's been using heroin since the age of 17 and has been supporting her C$75 a day habit by doing "anything legal I can take to get a few bucks."

Her addiction sometimes forces her to buy the drug from dealers she doesn't trust.

"It's a Russian roulette. And it scares the hell out of me," she said.

Tobin does not yet know whether she will be among the nearly 50 percent of study subjects receiving prescription heroin injections for 12 months, or the other half who will use methadone for comparison purposes.

Methadone treatment has not worked for her in the past, but she was optimistic nonetheless. "Once I get on here, I don't think I will come to street level heroin again," she said.

The study has encountered other setbacks. It was originally intended to include three cites, but while it has treatment sites in Vancouver and Montreal the plans for Toronto were scrapped because facility problems.

Researchers had originally wanted to work with addicts in the United States as well, but that idea was dropped even before the Canadian treatment sites were open.

"As you can imagine, the concept of medically prescribed heroin can be quite controversial. I'm not sure it was particularly welcomed by the U.S. government," said Schechter.

David Marsh, NAOMI's lead investigator said it's impossible at this stage of the study to determine any effects of prescription heroin therapy. Still, Tobin said she and others will be eagerly awaiting the results.

"I've often thought about what's going to happen when I'm 80 years old and in an old-age home, going 'Where's my heroin? Where's my heroin?"' Tobin said. "Hopefully, by then, it will be regulated and I'll be taken care of."

While researchers had intended to complete the study by February 2007, "it will likely be longer than that," Schechter said. "We're going to go as long as it takes."