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The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

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Abstract

The North American Opiate Medication Initiative (NAOMI) is a randomized controlled trial evaluating the feasibility and effectiveness of heroin-assisted treatment (HAT) in the Canadian context. 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 2005 and ended in March 2007. Inclusion criteria included opioid dependence, 5 or more years of opioid use, regular opioid injection, and at least two previous opiate addiction treatment attempts. Standardized assessment instruments such as the European Addiction Severity Index and the Maudsley Addiction Profile were employed. A total of 251 individuals were randomized from Vancouver, BC (192, 76.5%), and Montreal, Quebec (59, 23.5%); 38.5% were female, the mean age was 39.7 years (SD:8.6), and participants had injected drugs for 16.5 years (SD:9.9), on average. In the prior month, heroin was used a mean of 26.5 days (SD:7.4) and cocaine 16 days (SD;12.6). Vancouver had significantly more patients residing in unstable housing (88.5 vs. 22%; p < 0.001) and higher use of smoked crack cocaine (16.9 days vs. 2.3 days in the prior month; p < 0.001), while a significantly higher proportion of Montreal participants reported needle sharing in the prior 6 months (25% vs. 3.7%; p < 0.001). 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. This study suggests that the NAOMI study successfully recruited participants with a profile indicated for HAT. It also raises concern about the high levels of crack cocaine use and social marginalization.

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Acknowledgments

The NAOMI study is being funded by the Canadian Institute of Health Research.

The authors would like to thank Kara Sievewright, Kurt Lock, Sophie Alarie, Maryse Beaulieu, and Suzanne Marcotte for their priceless work interviewing participants; Vanessa Chu for editorial assistance; the NAOMI staff; and finally, to all the NAOMI participants.

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Authors and Affiliations

  1. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Eugenia Oviedo-Joekes, David C. Marsh, Aslam Anis & Martin T. Schechter

  2. Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada

    Eugenia Oviedo-Joekes, Bohdan Nosyk, Jill Chettiar, David C. Marsh, Michael Krausz, Aslam Anis & Martin T. Schechter

  3. Centre de recherche du l’Université de Montréal, Montreal, QC, Canada

    Suzanne Brissette & Pascal Schneeberger

  4. Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

    David C. Marsh & Michael Krausz

  5. Vancouver Coastal Health, Vancouver, BC, Canada

    David C. Marsh

  6. Centre for Addiction Research British Columbia, Vancouver, BC, Canada

    David C. Marsh

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  1. Eugenia Oviedo-Joekes
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  2. Bohdan Nosyk
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  3. Suzanne Brissette
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  4. Jill Chettiar
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  6. David C. Marsh
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  7. Michael Krausz
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  8. Aslam Anis
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  9. Martin T. Schechter
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Correspondence to Eugenia Oviedo-Joekes.

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Oviedo-Joekes, Marsh, Anis, and Schechter are with the School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Oviedo-Joekes, Nosyk, Chettiar, Marsh, Krausz, Anis, and Schechter are with the Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada; Brissette and Schneeberger are with the Centre de recherche du l’Université de Montréal, Montreal, QC, Canada; Marsh and Krausz are with the Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Marsh is with the Vancouver Coastal Health, Vancouver, BC, Canada; Marsh is with the Centre for Addiction Research British Columbia, Vancouver, BC, Canada.

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Oviedo-Joekes, E., Nosyk, B., Brissette, S. et al. The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment. J Urban Health 85, 812–825 (2008). https://doi.org/10.1007/s11524-008-9312-9

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