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.
Drug Alcohol Rev. 2018 Jan;37(1):137-146. doi: 10.1111/dar.12573. Epub 2017 Jun 8.
To determine the effectiveness of injectable hydromorphone and dicaetylmorphine for Indigenous participants in the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) clinical trial. The study additionally aims to explore the prevalence and frequency of crack cocaine use among subgroups of participants (by gender and ethnicity). This secondary analysis is particularly relevant given the current need for expanded medication assisted treatments for opioid dependence across North America.
Participants self-identifying as First Nations, Métis or Inuit were included in the analysis of Indigenous participants. Six-month treatment outcomes are reported as the difference between diacetylmorphine and hydromorphone treatment arms among Indigenous participants and change from baseline to 6 months in each treatment arm. Differences in outcomes are tested between Indigenous and non-Indigenous participants. Crack cocaine use was explored to determine differences between and within subgroups.
Approximately one-third of SALOME participants self-identified as Indigenous. Indigenous participants presented to treatment with more structural vulnerabilities (e.g. lower education, higher rates of foster care and separation from biological parents) compared to non-Indigenous participants. After 6 months, Indigenous participants in both treatment arms had a significant reduction in days of street heroin use, opioid use, crack cocaine use and illegal activity. Treatment retention did not differ by treatment arm.
Indigenous people that are not engaged by first-line treatments for opioid dependence are in need of effective alternative treatments. Given the political and logistical barriers facing diacetylmorphine, hydromorphone could serve as a more accessible medication to reach and treat this population. [Oviedo-Joekes E, Palis H, Guh D, Marchand K, Brissette S, Lock K, MacDonald S, Harrison S, Anis AH, Krausz M, March 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-termopioid dependence. Drug Alcohol Rev 2018;37:137-146].
确定在评估长效阿片类药物有效性研究（SALOME）临床试验中，注射用氢吗啡酮和二乙酰吗啡对原住民参与者的有效性。该研究还旨在探索参与者亚组（按性别和族裔划分）中可卡因裂缝的流行率和使用频率。鉴于当前北美地区对扩大阿片类药物依赖药物治疗的需求，这项二次分析尤其具有现实意义。
自我认同为第一民族、梅蒂斯或因纽特人的参与者被纳入原住民参与者的分析。报告了 6 个月的治疗结果，即二乙酰吗啡和氢吗啡酮治疗组之间的差异，以及每个治疗组从基线到 6 个月的变化。测试了原住民和非原住民参与者之间结果的差异。探讨了可卡因裂缝的使用情况，以确定亚组之间和亚组内的差异。
大约三分之一的 SALOME 参与者自我认同为原住民。与非原住民参与者相比，原住民参与者在治疗中存在更多的结构性脆弱性（例如，教育程度较低、更高的寄养和与亲生父母分离的比例）。6 个月后，两种治疗组的原住民参与者街头海洛因使用、阿片类药物使用、可卡因裂缝使用和非法活动的天数均显著减少。治疗保留率不因治疗组而异。
未通过一线阿片类药物依赖治疗的原住民需要有效的替代治疗方法。鉴于二乙酰吗啡面临的政治和后勤障碍，氢吗啡酮可以作为一种更容易获得的药物来接触和治疗这一人群。[Oviedo-Joekes E、Palis H、Guh D、Marchand K、Brissette S、Lock K、MacDonald S、Harrison S、Anis AH、Krausz M、March DC、Schechter MT。在一项随机对照试验中，接受注射用二乙酰吗啡或氢吗啡酮治疗的原住民的特征和对治疗的反应，以治疗长期阿片类药物依赖。药物和酒精审查 2018；37:137-146]。
