In this issue of JAMA Psychiatry, Oviedo-Joekes et al1 report the results of a single-site randomized noninferiority clinical trial in Vancouver, British Columbia, Canada, showing that supervised injection of hydromorphone hydrochloride is not inferior to supervised injection of heroin (diacetylmorphine hydrochloride) in long-term injection street opioid users. Supervised injection of diacetylmorphine (the active ingredient in heroin) and flexible doses of methadone hydrochloride had been previously evaluated compared with oral methadone treatment for those who had failed methadone maintenance.2 These studies found that supervised diacetylmorphine injection was effective in improving retention in treatment and reducing illicit drug use, incarceration, and criminal offenses. Because diacetylmorphine is not available in most countries, the study by Oviedo-Joekes et al1 sought to determine whether supervised injection of hydromorphone could provide an alternative to diacetylmorphine. The study results indicate that for an important, but small and carefully defined population, supervised injection of hydromorphone has comparable efficacy to supervised heroin injection when both are provided in structured, well-staffed medical programs.
Schottenfeld RS, O’Malley SS. Meeting the Growing Need for Heroin Addiction Treatment. JAMA Psychiatry. 2016;73(5):437-438. doi:10.1001/jamapsychiatry.2016.0139