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Morgan J, Neufeld SD, Holroyd H, Ruiz J, Taylor T, Nolan S, Glegg S. Community-Engaged Research Ethics Training (CERET): developing accessible and relevant research ethics training for community-based participatory research with people with lived and living experience using illicit drugs and harm reduction workers. Harm Reduct J 2023; 20:86. [PMID: 37415145 PMCID: PMC10324203 DOI: 10.1186/s12954-023-00818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Community-based participatory research (CBPR) can directly involve non-academic community members in the research process. Existing resources for research ethics training can be inaccessible to team members without an academic background and do not attend to the full spectrum of ethical issues that arise through community-engaged research practices. We detail an approach to capacity building and training in research ethics in the context of CBPR with people who use(d) illicit drugs and harm reduction workers in Vancouver's Downtown Eastside neighborhood. METHODS A project team comprised of academic and community experts in CBPR, research ethics, and harm reduction met over five months to develop the Community-Engaged Research Ethics Training (CERET). The group distilled key principles and content from federal research ethics guidelines in Canada, and developed case examples to situate the principles in the context of research with people who use(d) illicit drugs and harm reduction workers. In addition to content related to federal ethics guidelines, the study team integrated additional content related to ethical issues that arise through community-based research, and ethical principles for research in the Downtown Eastside. Workshops were evaluated using a pre-post questionnaire with attendees. RESULTS Over the course of six weeks in January-February 2020, we delivered three in-person workshops for twelve attendees, most of whom were onboarding as peer research assistants with a community-based research project. Workshops were structured around key principles of research ethics: respect for persons, concern for welfare, and justice. The discussion-based format we deployed allowed for the bi-directional exchange of information between facilitators and attendees. Evaluation results suggest the CERET approach was effective, and attendees gained confidence and familiarity with workshop content across learning objectives. CONCLUSIONS The CERET initiative offers an accessible approach to fulfill institutional requirements while building capacity in research ethics for people who use(d) drugs and harm reduction workers. This approach recognizes community members as partners in ethical decision making throughout the research process and is aligned with values of CBPR. Building capacity around intrinsic and extrinsic dimensions of research ethics can prepare all study team members to attend to ethical issues that arise from CBPR.
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Affiliation(s)
- Jeffrey Morgan
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
- BC Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, V6Z 2A9, Canada.
| | - Scott D Neufeld
- Department of Psychology, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Heather Holroyd
- BC Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, V6Z 2A9, Canada
- University of British Columbia, Learning Exchange, 612 Main St, Vancouver, BC, V6A 2V3, Canada
| | - Jean Ruiz
- University of British Columbia, Office of Research Ethics, 6190 Agronomy Rd., Vancouver, BC, V6T 1Z3, Canada
| | - Tara Taylor
- Overdose Prevention Society, 390 Columbia St., Vancouver, BC, V6A 4J1, Canada
- SpencerCreo Foundation, 610 Main St, Vancouver, BC, V6A 2V3, Canada
| | - Seonaid Nolan
- BC Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Stephanie Glegg
- BC Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, V6Z 2A9, Canada
- Occupational Science and Occupational Therapy, University of British Columbia, T325-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada
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Williamson L. Creating an ethical culture to support recovery from substance use disorders. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106661. [PMID: 33177147 PMCID: PMC8639939 DOI: 10.1136/medethics-2020-106661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/07/2020] [Accepted: 09/23/2020] [Indexed: 05/08/2023]
Abstract
There is a long-standing failure to create an ethical culture around substance use disorders (SUDs) or dependence that actively supports people's recovery efforts. Issues which impede the development of prorecovery environments are complex, but include the far-reaching effects of the social stigma that surrounds SUDs; and the failure to harness relational and social support that allows debates to transcend blaming individual substance users. As part of efforts to create prorecovery environments, it is important to acknowledge that bioethics debate on SUDs is narrow in scope, prioritising topics related to its traditional interests in individual autonomy and novel technologies. As a result, it has not played a significant role in helping to transform the ethical cultures in which substance use recovery takes place. For example, it largely neglects the ethical challenges of developing an empathic, person-centred approach to substance use problems that listens and responds to the voices of clients. It has also participated little in efforts to develop a positive response to reducing the toxic effects of stigma. Indeed, some contributions from the field fan stigma, rather than alleviate it. The aim of this paper is to seed broader ethical debate, in academic literature and lay/professional communities, on how societies should respond to SUDs: steering a course between the critical, but narrow approach of bioethics and the empowerment discourse of evidence-based treatments.
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Affiliation(s)
- Laura Williamson
- Center for Bioethics and Health Policy, Institute of Public & Preventive Health, Augusta University, Augusta, Georgia, USA
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Oviedo-Joekes E, Palis H, Guh D, Marchand K, Brissette S, Lock K, MacDonald S, Harrison S, Anis AH, Krausz M, Marsh DC, Schechter MT. Characteristics and response to treatment among Indigenous people receiving injectable diacetylmorphine or hydromorphone in a randomised controlled trial for the treatment of long-term opioid dependence. Drug Alcohol Rev 2017; 37:137-146. [DOI: 10.1111/dar.12573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/23/2017] [Accepted: 04/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Eugenia Oviedo-Joekes
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
- School of Population and Public Health; University of British Columbia; Vancouver Canada
| | - Heather Palis
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
- School of Population and Public Health; University of British Columbia; Vancouver Canada
| | - Daphne Guh
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
| | - Kirsten Marchand
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
- School of Population and Public Health; University of British Columbia; Vancouver Canada
| | - Suzanne Brissette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM); Montréal Canada
| | - Kurt Lock
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
| | | | - Scott Harrison
- Crosstown Clinic; Providence Health Care; Vancouver Canada
| | - Aslam H. Anis
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
| | - Michael Krausz
- Department of Psychiatry; University of British Columbia; Vancouver Canada
| | | | - Martin T. Schechter
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
- School of Population and Public Health; University of British Columbia; Vancouver Canada
- Centre for Excellence in Indigenous Health, Faculty of Medicine; University of British Columbia; Vancouver Canada
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Boyd S, Murray D, MacPherson D. Telling our stories: heroin-assisted treatment and SNAP activism in the Downtown Eastside of Vancouver. Harm Reduct J 2017; 14:27. [PMID: 28521781 PMCID: PMC5437683 DOI: 10.1186/s12954-017-0152-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/05/2017] [Indexed: 11/25/2022] Open
Abstract
Background This 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. Methods This 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. Results The 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. Conclusions HAT 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.
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Affiliation(s)
- Susan Boyd
- Faculty of Human and Social Development, University of Victoria, Victoria, BC, V8W 2Y2, Canada
| | - Dave Murray
- c/o VANDU, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | | | - Donald MacPherson
- Canadian Drug Policy Coalition, Centre for Applied Research in Mental Health and Addictions, Simon Fraser University, #2400 - 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.
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Jozaghi E. "SALOME gave my dignity back": the role of randomized heroin trials in transforming lives in the Downtown Eastside of Vancouver, Canada. Int J Qual Stud Health Well-being 2014; 9:23698. [PMID: 24646474 PMCID: PMC3955773 DOI: 10.3402/qhw.v9.23698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 12/03/2022] Open
Abstract
Although numerous studies on heroin-assisted treatment (HAT) have been published in leading international journals, little attention has been given to HAT’s clients, their stories, and what constitutes the most influential factor in the treatment process. The present study investigates the role of HAT in transforming the lives of injection drug users (IDUs) in Vancouver, Canada. This study is qualitative focusing on 16 in-depth interviews with patients from the randomized trials of HAT. Interviews were transcribed verbatim and analyzed thematically using NVivo 10 software. The findings revealed a positive change in many respects: the randomized trials reduce criminal activity, sex work, and illicit drug use. In addition, the trials improved the health and social functioning of its clients, with some participants acquiring work or volunteer positions. Many of the participants have been able to reconnect with their family members, which was not possible before the program. Furthermore, the relationship between the staff and patients at the project appears to have transformed the behavior of participants. Attending HAT in Vancouver has been particularly effective in creating a unique microenvironment where IDUs who have attended HAT have been able to form a collective identity advocating for their rights. The result of this research points to the need for continuation of the project beyond the current study, leading toward a permanent program.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, Burnaby, Canada
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Boyd S, NAOMI Patients Association. Yet they failed to do so: recommendations based on the experiences of NAOMI research survivors and a call for action. Harm Reduct J 2013; 10:6. [PMID: 23594923 PMCID: PMC3646696 DOI: 10.1186/1477-7517-10-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 04/01/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This article highlights the experiences of a unique group. In January 2011, Dave Murray organized a group of participants from the North American Opiate Medication Initiative (NAOMI) heroin-assisted treatment clinical trials from 2005 to 2008 in the Downtown Eastside of Vancouver (DTES), B.C., Canada. The NAOMI Patients Association (NPA) is an independent group that currently meets every Saturday in the DTES. Currently, all members of the NPA are former participants in the heroin stream of the clinical trial. The NPA offers support, education, and advocacy to its members. METHODS Drawing on brainstorming sessions and focus groups that were conducted in the summer of 2011, this paper highlights the experiences of NPA members in their own words. RESULTS The findings provide a lens to understand how becoming a research subject for the NAOMI trial impacted the lives of NPA members, both positive and negative. The NPA members discuss ethics, consent, recommendations for future HAT programs and studies, and ongoing advocacy.
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Affiliation(s)
- Susan Boyd
- Studies in Policy & Practice, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
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Small D. Canada's highest court unchains injection drug users; implications for harm reduction as standard of healthcare. Harm Reduct J 2012; 9:34. [PMID: 22817679 PMCID: PMC3492113 DOI: 10.1186/1477-7517-9-34] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 07/04/2012] [Indexed: 11/23/2022] Open
Abstract
North America’s only supervised injection facility, Insite, opened its doors in September of 2003 with a federal exemption as a three-year scientific study. The results of the study, evaluated by an independent research team, showed it to be successful in engaging the target group in healthcare, preventing overdose death and HIV infections while increasing uptake and retention in detox and treatment. The research, published in peer-reviewed medical and scientific journals, also showed that the program did not increase public disorder, crime or drug use. Despite the substantial evidence showing the effectiveness of the program, the future of Insite came under threat with the election of a conservative federal government in 2006. As a result, the PHS Community Services Society (PHS), the non-profit organization that operates Insite, launched a legal case to protect the program. On 30 September 2011, Supreme Court of Canada ruled in favour of Insite and underscored the rights of people with addictions to the security of their person under section 7 of the Charter of Rights and Freedoms (Charter of Rights). The decision clears the ground for other jurisdictions in Canada, and perhaps North America, to implement supervised injection and harm reduction where it is epidemiologically indicated. The legal case validates the personhood of people with addictions while metaphorically unchaining them from the criminal justice system.
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Affiliation(s)
- Dan Small
- PHS Community Services Society, 20 West Hastings Street, Vancouver, British Columbia, V6B 1G6, Canada.
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Aceijas C. The Ethics in Substitution Treatment and Harm Reduction. An Analytical Review. Public Health Rev 2012. [DOI: 10.1007/bf03391668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Braden M, McGowan IW, McLaughlin DF, McKenna HP, Keeney S, Quinn B. Users, carers and professionals experiences of treatment and care for heroin dependency: Implications for practice. A preliminary study. JOURNAL OF SUBSTANCE USE 2010. [DOI: 10.3109/14659891.2010.495818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Perea-Milla E, Ayçaguer LCS, Cerdà JCM, Saiz FG, Rivas-Ruiz F, Danet A, Vallecillo MR, Oviedo-Joekes E. Efficacy of prescribed injectable diacetylmorphine in the Andalusian trial: Bayesian analysis of responders and non-responders according to a multi domain outcome index. Trials 2009; 10:70. [PMID: 19682360 PMCID: PMC2739523 DOI: 10.1186/1745-6215-10-70] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 08/14/2009] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The objective of this research was to evaluate data from a randomized clinical trial that tested injectable diacetylmorphine (DAM) and oral methadone (MMT) for substitution treatment, using a multi-domain dichotomous index, with a Bayesian approach. METHODS Sixty two long-term, socially-excluded heroin injectors, not benefiting from available treatments were randomized to receive either DAM or MMT for 9 months in Granada, Spain. Completers were 44 and data at the end of the study period was obtained for 50. Participants were determined to be responders or non responders using a multi-domain outcome index accounting for their physical and mental health and psychosocial integration, used in a previous trial. Data was analyzed with Bayesian methods, using information from a similar study conducted in The Netherlands to select a priori distributions. On adding the data from the present study to update the a priori information, the distribution of the difference in response rates were obtained and used to build credibility intervals and relevant probability computations. RESULTS In the experimental group (n = 27), the rate of responders to treatment was 70.4% (95% CI 53.287.6), and in the control group (n = 23), it was 34.8% (95% CI 15.354.3). The probability of success in the experimental group using the a posteriori distributions was higher after a proper sensitivity analysis. Almost the whole distribution of the rates difference (the one for diacetylmorphine minus methadone) was located to the right of the zero, indicating the superiority of the experimental treatment. CONCLUSION The present analysis suggests a clinical superiority of injectable diacetylmorphine compared to oral methadone in the treatment of severely affected heroin injectors not benefiting sufficiently from the available treatments. TRIAL REGISTRATION Current Controlled Trials ISRCTN52023186.
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Affiliation(s)
- Emilio Perea-Milla
- Research Support Unit, Hospital Costa del Sol, Ctra Nacional 340, km 187, 29603 Marbella, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Luis Carlos Silva Ayçaguer
- National Center for Medical Science Information (INFOMED), 27 St N#110. Vedado, 10400 Ciudad de la Habana, Cuba
| | - Joan Carles March Cerdà
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Andalusian School of Public Health, Campus Universitario de Cartuja, Cuesta del Observatorio 4, Apartado 2070, 18080, Granada, Spain
| | - Francisco González Saiz
- Andalusian Foundation for Drug Abuse Attendance (FADA), Avda. Hytasa Edf. Toledo II Planta 2 Oficina 3, 41006, Seville, Spain
| | - Francisco Rivas-Ruiz
- Research Support Unit, Hospital Costa del Sol, Ctra Nacional 340, km 187, 29603 Marbella, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Alina Danet
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Andalusian School of Public Health, Campus Universitario de Cartuja, Cuesta del Observatorio 4, Apartado 2070, 18080, Granada, Spain
| | - Manuel Romero Vallecillo
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Andalusian School of Public Health, Campus Universitario de Cartuja, Cuesta del Observatorio 4, Apartado 2070, 18080, Granada, Spain
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia & Centre for Health Evaluations and Outcomes, Providence Health Care, Vancouver, BC, Canada
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Oviedo-Joekes E, Nosyk B, Marsh DC, Guh D, Brissette S, Gartry C, Krausz M, Anis A, Schechter MT. Scientific and political challenges in North America's first randomized controlled trial of heroin-assisted treatment for severe heroin addiction: rationale and design of the NAOMI study. Clin Trials 2009; 6:261-71. [PMID: 19528135 PMCID: PMC5127700 DOI: 10.1177/1740774509105222] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Heroin addiction is a chronic relapsing disease, best treated with opioid-agonist substitution therapy such as methadone maintenance. However, a subset of the most severely affected individuals do not benefit sufficiently from this treatment. The North American Opiate Medication Initiative (NAOMI) is a randomized clinical trial (RCT) to evaluate the hypothesis that pharmaceutical-grade heroin, diacetylmorphine (DAM) is more effective in retaining patients and improving their outcomes than Methadone Maintenance Treatment (MMT) among those with chronic, refractory injection opioid dependence. PURPOSE/METHODS The study aimed at randomizing 253 participants to two intervention arms: (1) MMT alone or (2) injectable opioids (DAM or hydromorphone) plus adjunctive MMT if deemed appropriate. The planned study duration was 3 years, with a 1-year intake period, 1 year of treatment, and an additional year of follow-up. The NAOMI trial was initiated in March 2005 at two Canadian sites (Vancouver and Montreal). This was the first multicenter RCT in North America to compare the relative efficacy of these different therapeutic strategies. We discuss the rationale behind the NAOMI study design, as well as the scientific and political issues and methodological challenges arising from the conduct of a trial that involves the prescription of a controlled substance to individuals with dependence on that substance. LIMITATIONS Restrictive entry criteria led to the exclusion of many otherwise eligible participants, slowing recruitment into the study. Inability to offer DAM treatment beyond 12 months led to artificial boundary effects in the trial. CONCLUSIONS Addiction treatment research navigates between science and politics, and evidence-based medicine is many times confronted by moral beliefs. Political considerations influence study design to a further degree than in RCTs treating less-stigmatized disorders with more-reputable medications.
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Affiliation(s)
- Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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Gartry CC, Oviedo-Joekes E, Laliberté N, Schechter MT. NAOMI: The trials and tribulations of implementing a heroin assisted treatment study in North America. Harm Reduct J 2009; 6:2. [PMID: 19159475 PMCID: PMC2639576 DOI: 10.1186/1477-7517-6-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Accepted: 01/21/2009] [Indexed: 01/15/2023] Open
Abstract
Background Opioid addiction is a chronic, relapsing disease and remains a major public health challenge. Despite important expansions of access to conventional treatments, there are still significant proportions of affected individuals who remain outside the reach of the current treatment system and who contribute disproportionately to health care and criminal justice costs as well as to public disorder associated with drug addiction. The NAOMI study is a Phase III randomized clinical trial comparing injectable heroin maintenance to oral methadone. The study has ethics board approval at its Montréal and Vancouver sites, as well as from the University of Toronto, the New York Academy of Medicine and Johns Hopkins University. The main objective of the NAOMI Study is to determine whether the closely supervised provision of injectable, pharmaceutical-grade opioid agonist is more effective than methadone alone in recruiting, retaining, and benefiting chronic, opioid-dependent, injection drug users who are resistant to current standard treatment options. Methods The case study submitted chronicles the challenges of getting a heroin assisted treatment trial up and running in North America. It describes: a brief background on opioid addiction; current standard therapies for opioid addiction; why there is/was a need for a heroin assisted treatment trial; a description of heroin assisted treatment; the beginnings of creating the NAOMI study in North America; what is the NAOMI study; the science and politics of the NAOMI study; getting NAOMI started in Canada; various requirements and restrictions in getting the study up and running; recruitment into the study; working with the media; a status report on the study; and a brief conclusion from the authors' perspectives. Results and conclusion As this is a case study, there are no specific results or main findings listed. The case study focuses on: the background of the study; what it took to get the study started in Canada; the unique requirements and conditions of getting a site, and the study, approved; working with the media; recruitment into the study; a brief status report on the study; and a brief conclusion from the authors' perspectives. Trail Registration ClinicalTrials.gov registration number: NCT00175357
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Affiliation(s)
- Candice C Gartry
- CIHR Canadian HIV Trials Network and the Centre for Health Evaluation & Outcome Sciences (CHEOS), Vancouver, BC, Canada.
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Fighting addiction's death row: British Columbia Supreme Court Justice Ian Pitfield shows a measure of legal courage. Harm Reduct J 2008; 5:31. [PMID: 18957091 PMCID: PMC2611970 DOI: 10.1186/1477-7517-5-31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 10/28/2008] [Indexed: 11/23/2022] Open
Abstract
The art in law, like medicine, is in its humanity. Nowhere is the humanity in law more poignant than in BC Supreme Court Justice Ian Pitfield's recent judgment in the legal case aimed at protecting North America's only supervised injection facility (SIF) as a healthcare program: PHS Community Services Society versus the Attorney General of Canada. In order to protect the SIF from politicization, the PHS Community Services Society, the community organization that established and operates the program, along with two people living with addiction and three lawyers working for free, pro bono publico, took the federal government of Canada to court. The courtroom struggle that ensued was akin to a battle between David and Goliath. The judge in the case, Justice Pitfield, ruled in favour of the PHS and gave the Government of Canada one year to bring the Controlled Drugs and Substances Act (CDSA) into compliance with the country's Charter of Rights and Freedoms. If parliament fails to do so, then the CDSA will evaporate from enforceability and law in June of 2009. Despite the fact that there are roughly twelve million intravenous drug addiction users in the world today, politics andprejudice oards harm reduction are still a barrier to the widespread application of the "best medicine" available for serious addicts. Nowhere is this clearer than in the opposition by conservative Prime Minister Stephen Harper and his faithful servant, federal health minister Tony Clement, towards Vancouver's SIF ("Insite"). The continued angry politicization of addiction will only lead to the tragic loss of life, as addicts are condemned to death from infectious diseases (HIV & hepatitis) and preventable overdoses. In light of the established facts in science, medicine and now law, political opposition to life-saving population health programs (including SIFs) to address the effects of addiction is a kind of implicit capital punishment for the addicted. This commentary examines the socio-political context of the legal case and the major figures that contributed to it. It reviews Justice Pitfield's ruling, a judgment that has brought Canada one step closer to putting a stop to addiction's death row where intravenous drug users are needlessly, for political and ideological reasons alone, forced to face increased risks of death due to AIDS, hepatitis and overdose.
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Small D. Amazing grace: Vancouver's supervised injection facility granted six-month lease on life. Harm Reduct J 2008; 5:3. [PMID: 18218101 PMCID: PMC2233622 DOI: 10.1186/1477-7517-5-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 01/24/2008] [Indexed: 11/30/2022] Open
Abstract
Addiction should be a matter, primarily, for the Chief of Medicine rather than the Chief of Police. While internationally renowned for its social kindness, Canada has not been without its share of disgraceful political mistakes in the not too distant past. Regrettably, there are many shameful events in Canada that have unfolded in the name of public policy including the banishment without medical treatment of Chinese Canadians living with leprosy to die on D'Arcy and Bentinck Islands in British Columbia while European Canadians stricken similarly enjoyed healthcare on the mainland as well as the eternally haunting treatment of people of aboriginal ancestry who were without full voting privileges in some parts of Canada until 1965 and abandoned to encampments, reserves, that paralleled South African apartheid. In due course, these public policies have come to be understood as horrific in retrospect. Many have all met with a remorseful fate where a future Prime Minister is held to public account for the sad excesses of an earlier generation. With respect to North America's only supervised injection facility (SIF), a medical program aimed at reducing fatal overdoses and infections (HIV, HCV) in injection drug users, Canada's Prime Minister Stephen Harper holds the ability to forestall a similarly heartrending fate in his political hands. The SIF currently has a temporary exemption from Canada's "Controlled Drugs and Substances Act" in order to operate until June of 2008. As such, the fate of the SIF is politically determined each time behind closed doors by the Prime Minister and his ministers. Sadly, the Prime Minister appears lost at present, content to ignore the scientific and medical evidence on the matter of population health. In light of the vast medical evidence accumulated on Vancouver's SIF, the fate of injection facilities needs to be taken out of the political realm entirely. I am hoping that the Prime Minister will be found, see the light of the scientific evidence, and lead the way towards to provision of a permanent medical exemption for injection facilities from Canada's Controlled Drugs and Substances Act (CDSA). In so doing, the Prime Minister would be on the brink of grace and would rescue a life saving health program from perpetual political interference.
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Affiliation(s)
- Dan Small
- Department of Medicine, University of British Columbia, Vancouver, Canada.
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15
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Haden M. Controlling illegal stimulants: a regulated market model. Harm Reduct J 2008; 5:1. [PMID: 18215317 PMCID: PMC2238741 DOI: 10.1186/1477-7517-5-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 01/23/2008] [Indexed: 11/10/2022] Open
Abstract
Prohibition of illegal drugs is a failed social policy and new models of regulation of these substances are needed. This paper explores a proposal for a post-prohibition, public health based model for the regulation of the most problematic drugs, the smokable and injectable stimulants. The literature on stimulant maintenance is explored. Seven foundational principles are suggested that could support this regulatory model of drug control that would reduce both health and social problems related to illegal stimulants. Some details of this model are examined and the paper concludes that drug policies need to be subject to research and based on evidence.
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Affiliation(s)
- Mark Haden
- Vancouver Coastal Health Authority, Pacific Spirit Community Health Centre, 2110 West 43rd Ave, Vancouver, British Columbia, V6K 2E1, Canada.
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16
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McCurdy S, Kilonzo GP, Williams M, Kaaya S. Harm reduction in Tanzania: An urgent need for multisectoral intervention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:155-9. [PMID: 17689361 DOI: 10.1016/j.drugpo.2007.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 04/27/2007] [Accepted: 05/02/2007] [Indexed: 11/16/2022]
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17
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Chatwin C. Multi-level governance: The way forward for European illicit drug policy? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:494-502. [PMID: 18061875 DOI: 10.1016/j.drugpo.2006.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Revised: 11/03/2006] [Accepted: 12/13/2006] [Indexed: 11/19/2022]
Abstract
Illicit drug policy has long been an area that has attracted international policy intervention, however, the European Union has declared it an area of subsidiarity, leaving ultimate control to national governments. Nevertheless, European Union preoccupation with the illicit drug issue and international drug trafficking and organised crime concerns have ensured that continued and increased cooperation in illicit drug policy is never off the agenda. This article examines the history of European integration in contrasting areas of policy and considers both the desirability and the viability of an increasingly harmonised drug policy for Europe. Finally, it proposes a model of integrated illicit drug policy that is strongly connected to developing patterns of European social policy, calling on multi-level governance and close involvement at the level of the citizen.
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Affiliation(s)
- Caroline Chatwin
- Middlesex University, Queensway, Southbury, Middlesex EN3 4SF, United Kingdom.
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