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Official websites use. Share sensitive information only on official, secure websites. Our objective is to analyze the profile of the NAOMI participant cohort in the context of illicit opioid use in Canada and to evaluate its comparability with patient profiles of European HAT studies. Recruitment began in February and ended in March Inclusion criteria included opioid dependence, 5 or more years of opioid use, regular opioid injection, and at least two previous opiate addiction treatment attempts. A total of individuals were randomized from Vancouver, BC , In the prior month, heroin was used a mean of Vancouver had significantly more patients residing in unstable housing 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. It also raises concern about the high levels of crack cocaine use and social marginalization. Heroin addiction is a chronic relapsing disease and is often accompanied by abuse of other psychoactive drugs, physical and mental health problems, and severe social marginalization. Between 75, and , people inject drugs in Canada, with cocaine and heroin the favored injectable substances of choice. Injectors are exposed to life-threatening health risks such as drug overdoses, blood-borne viral infections, endocarditis, and others. Evidence shows that MMT is effective 19 if delivered under best practices guidelines. Although MMT has been proven to be effective for some, it is well documented that a significant proportion of patients are not attracted into or do not respond to this therapy. Heroin-assisted treatment HAT , in which patients are prescribed pharmaceutical quality heroin diacetylmorphine in specialized clinics, is one available therapeutic option for chronic, long-term, opioid injectors who remain outside of the current addiction treatment system. Clinical trials and follow-up studies have demonstrated that prescribed heroin is safe, feasible, and effective. The objective of the present analysis is to describe the profile of the subjects recruited into NAOMI and to evaluate the comparability with international patient profiles of other studies of HAT. The NAOMI study was designed as an open, randomized controlled trial that compares injected diacetylmorphine DAM; plus oral methadone if deemed appropriated with oral methadone alone in the treatment of opioid addiction for chronic injection opioid users who have not benefited from available therapies. Patients in both arms of the trial also receive an identical comprehensive range of psychosocial and primary care services. Recruitment began in February and ended in March , with participants recruited. The trial was originally planned for three sites, but construction delays and other factors precluded the proposed Toronto site from participating. The recruitment strategy included an intensive outreach campaign, posters, on-the-street contact, media advertisement, and referrals from services that work with the same target population e. Participants must have had a minimum of two previous opiate addiction treatments, including one in which they received a minimum of 60 mg or more of methadone daily for at least 30 days in a day period. To participate in the study, the candidates could not have been enrolled in methadone maintenance treatment within the prior 6 months. Other exclusion criteria included severe medical or psychiatric conditions that are contraindicated for HAT, pregnancy, and current justice system involvement that could have resulted in an extended period of incarceration during the study period. The screening period for each participant involved a minimum of 3 weeks from initial contact up to the time when all necessary eligibility criteria had been determined and confirmed average 6 weeks. As eligible patients completed the screening, they provided informed consent and underwent the baseline assessment. For purposes of validation, a subset of participants in the injection arm was randomly assigned to receive hydromorphone HDM instead of DAM on a double-blind basis. Descriptive analyses were performed for frequencies and means values. Statistical analyses were conducted using SPSS A total of 1, people were contacted and went through the self-report step of the screening process 1, in Vancouver and in Montreal , and were assessed for eligibility. Among them, dropped out from the screening process, and were not eligible mainly due to not meeting the MMT history inclusion criteria they did not get at least 30 days of MMT at 60 mg, or they were currently or recently on MMT, or they did not have a verifiable history of MMT. A total of clients met the eligibility criteria and provided informed consent including 59 Random assignments were as follows: oral methadone Unstable housing was described as having no fixed address, living in a shelter, or living in a SRO single room occupancy hotel. The mean age of the study sample at recruitment was A total of In the prior 3 years, most of the participants had been regularly unemployed Overall, the two most frequently cited sources of income were public assistance Almost all of the participants In the month prior to baseline assessment, This difference is significant even after adjusting for age, housing, and crack use in the prior month. NAOMI participants reported an extensive history of regular drug use, with heroin and cocaine being the most commonly used drugs. Data on recent drug use in the prior 30 days showed similar patterns Table 2. Cocaine was almost always smoked as crack cocaine a mean days of Speedball, a combination of heroin and cocaine, was used a mean of 2. Besides heroin, nonprescribed methadone, hydromorphone, and morphine were the three most common illicit opioids used by the participants; however, their use was minimal in comparison to heroin use. Compared to Vancouver, Montreal participants reported a higher mean days of use in the prior month of alcohol, injected cocaine, and cannabis. Vancouver participants, however, reported greater use of smoked crack cocaine, amphetamines, speedball, illicit hydromorphone, and illicit morphine. Half of the sample Table 3 reported a significant chronic medical problem, and almost all had been hospitalized at least once Vancouver participants had higher proportions of chronic health problems and hospitalizations even after adjusting for age and gender. One third of the sample Almost half of the sample has never remained abstinent for more than 3 months after drug treatment with similar patterns at both sites. Despite shorter lifetime durations of heroin use, Montreal participants reported higher lifetime numbers of overdoses. There were marked differences in risk behaviors between the two cities. A quarter of Montreal participants reported sharing needles sometimes or often in the prior 6 months compared to only 3. This difference remained significant even after adjusting for age and use of injected cocaine. The NAOMI participants were somewhat older, but this is not surprising given the inclusion criterion of age 25 or greater. Also, the Canadian sample has a remarkably higher proportion of unstable housing. Although NAOMI is similar to the other studies with respect to unemployment and frequency of illegal activity, more NAOMI subjects rely on illegal income and less on welfare assistance. Days of heroin and cocaine use in the prior month were remarkably similar in the different settings, although NAOMI participants reported spending significantly higher amounts on the purchase of drugs. Analysis of the baseline characteristics of participants in the NAOMI trial demonstrates successful recruitment of the target population: long-term, chronic opioid injectors with severe health and social problems, and several previous addiction treatment attempts. In addition, almost all the participants are polydrug users with cocaine being the second most popular drug of choice, after heroin. Vancouver participants had more severe problems when compared to Montreal participants in relation to unstable housing status, criminal activity, physical health status, and crack cocaine use. It has been previously reported that there is a higher proportion of injection equipment sharing and overdoses in Montreal compared to Vancouver. On the other hand, Montreal participants have received more psychological treatment than Vancouver and have been on MMT more times. While Vancouver has seen a more rapid expansion in availability of MMT over the past 15 years than Montreal, many of the methadone programs include minimal levels of psychological supports, whereas these are standard components of MMT in Montreal. Number of MMT attempts may differ in the two cities as well because of the differences in treatment delivery systems with Montreal having both maintenance and short-term MMT available, the latter being focused on providing opportunities for physical health assessment, counseling, and referral to community resources such as housing. British Columbia is the only province in Canada which allows methadone clinics to charge user fees, and this may result in a barrier to treatment re-entry for some former MMT patients. The Canadian sample shows similarities with the other studies in relation to drug use and treatment history, employment and legal status, and health Table 4. However, NAOMI participants have a higher proportion of females, have poorer housing, have less support from welfare assistance, and spend more money on drugs than participants in all other HAT studies at baseline. In the international literature related to opioid dependence, the expected ratio of females to males is usually At least in Vancouver, this is consistent with the literature; the proportion of women in MMT in British Columbia is Luc Cohort study with IDUs. Either the biases are the same, or the figures in this study are representing a truly higher proportion of female heroin chronic users, at least in Vancouver. The Montreal situation is less clear. Housing status is a strong predictor of drug treatment outcome. Given the relationship between negative consequences from addiction and availability of secure affordable housing, all interventions should strive to address both problems for greatest efficacy. Aside from local differences in the drug scenes between the two cities, it is important to note that, in both cities, the housing situation shows indicators of instability and vulnerability. Furthermore, Montreal participants tended to live with people with alcohol and drug problems, whereas the Vancouver participants tended to live alone. Both situations present challenges in the recovery process of drug-dependent people. Thus, cocaine use in any form among opioid-dependant people has become a significant problem for service providers. Evaluation of cocaine use among MMT patients does not show promising results, although results are better if accompanied by psychosocial therapy. Also, daily cocaine users tend to drop out earlier from treatment. This study presents the profile of a selected group of opioid-dependent people: adult, chronic heroin-injecting users for whom available treatments have failed repeatedly in the course of their substance dependence. The data presented here features the limitations of intentional sampling and cross-sectional studies. Thus, generalizations should be made cautiously, and conclusions of causal relationships should be avoided. It also raises a special concern about the high stimulant use and the high level of social marginalization among this sample of opioid injectors. As a library, NLM provides access to scientific literature. J Urban Health. Find articles by Eugenia Oviedo-Joekes. Find articles by Bohdan Nosyk. Find articles by Suzanne Brissette. Find articles by Jill Chettiar. Find articles by Pascal Schneeberger. Find articles by David C Marsh. Find articles by Michael Krausz. Find articles by Aslam Anis. Find articles by Martin T Schechter. Open in a new tab. 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