Injectable hydromorphone for individuals with severe opioid use disorder could save lives and money
Vancouver, March 27, 2018 – Injectable hydromorphone treatment for severe opioid use disorder may reduce mortality and save costs to society compared to providing methadone alone. The findings come from an economic analysis of the groundbreaking SALOME trial, published this week in Addiction (link will be made available after the study is released.)
SALOME (Study to Assess Longer-term Opioid Medication Effectiveness) originally found injectable hydromorphone, a licensed opioid also known as Dilaudid, to be as effective as diacetylmorphine (pharmaceutical heroin) for people who have not benefited from previous treatments, such as methadone or suboxone.
SALOME is the follow-up study to the North American Opiate Medication Initiative (NAOMI), North America’s first-ever clinical trial of diacetylmorphine/prescription heroin as an opioid agonist treatment medication.
“This ground-breaking B.C. research supports the Ministry of Mental Health and Addictions work to offer a full spectrum of treatment options so that more people with opioid addiction can find a pathway to hope and recovery that works for them,” said Judy Darcy, Minister of Mental Health and Addictions. “The goal of everything we are doing is to save more lives and connect more people to treatment and recovery services as soon as possible.”
“Our results suggest that funding injectable hydromorphone, a legally approved pain-management drug, reduces mortality, increases quality of life and saves overall costs, when compared to methadone alone.” said lead author Dr. Nick Bansback, researcher at the Centre for Health Evaluation and Outcome Sciences (CHÉOS) at St. Paul’s Hospital and associate professor at the UBC School of Population and Public Health.
Although the direct cost of hydromorphone is higher than methadone, the study indicated these costs would be saved by retaining individuals in treatment for longer, and consequently reducing the hospitalizations and criminal activity that rise when people are not retained in any treatment. Dr. Bansback adds, “The results are similar between hydromorphone and diacetylmorphine, but since hydromorphone is already a licensed opioid, this might be more straightforward treatment to implement.”
In this economic assessment, researchers compared the economic outcomes of the 202 individuals included in the SALOME trial and used the findings of NAOMI and SALOME as a basis for lifetime individual projections of risk of mortality, and approximate costs of treatment, involvement in crime, and other health care utilization. These costs included opioid substitution treatment, treatment for HIV infection, other health care use, self-reported criminal activity, and criminal charges. The actual cost savings depend on the negotiated drug price and costs related to drug product preparation.
Key findings of the research include:
- In the lifetime analysis, hydromorphone was estimated to provide individuals with more than three additional years of life, on average, compared to methadone alone.
- Over a lifetime, the provision of hydromorphone could save society $140,000 per individual, with most savings occurring through reductions in the involvement in property and violent crime.
- The analysis was not able to include measured changes in the possession or dealing of drugs, disorderly conduct, sex work, major driving violations, or broken conditions imposed by the judicial system, which would likely demonstrate even greater cost savings.
Dr. Eugenia Oviedo-Joekes, the principal investigator of the SALOME study, said, “We now have Canadian evidence of efficacy and cost savings of injectable opioid agonist treatment. We hope this evidence helps overcome implementation barriers and leads to the expansion of much needed treatment with injectable opioids.” SALOME started in late 2011 and concluded in late 2015. The study received funding from the Canadian Institutes of Health Research (CIHR) and private donors through the fundraising efforts of the InnerChange Foundation and St. Paul’s Foundation. Providence Health Care funded clinical care for participants during the study. The study was led by researchers from Providence Health Care, CHÉOS and the UBC School of Population and Public Health. The cost of the study was $7.4 million.
For more information on SALOME including b-roll you can download, please visit www.providencehealthcare.org/salome/.
To read the press release for the original SALOME trial, please visit
Providence Health Care (PHC) is one of Canada's largest faith-based health care organizations, operating 17 health care facilities in Greater Vancouver. PHC operates one of two adult academic health science centres in the province — St. Paul’s Hospital — performs cutting-edge research in more than 30 clinical specialties, and focuses its services on six “populations of emphasis”: cardio-pulmonary risks and illnesses, HIV/AIDS, mental health, renal risks and illness, specialized needs in aging, and urban health and is home to the B.C. Centre for Excellence in HIV/AIDS. www.providencehealthcare.org.
The Centre for Health Evaluation and Outcome Sciences: A centre of the Providence Health Care Research Institute (PHCRI) and the University of British Columbia, the Centre for Health Evaluation and Outcome Sciences (CHÉOS) is a multidisciplinary research collective founded to pursue excellence through the evaluation, interpretation, and dissemination of health outcomes information. CHÉOS works across all of PHCRI’s health disciplines, including aging, cardiopulmonary health, urban health, HIV/AIDS, mental health, and kidney health. www.cheos.ubc.ca.
The University of British Columbia (UBC) is one of North America’s largest public research and teaching institutions,and is consistently ranked among the world’s 40 best universities. Surrounded by the beauty of the Canadian West, it is a place that inspires bold, new ways of thinking that have helped make it a national leader in areas as diverse as community service learning, sustainability, and research commercialization. UBC offers more than 58,000 students a range of innovative programs and attracts $519 million per year in research funding from government, non-profit organizations, and industry through over 8,000 projects and grants.
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For more information:
Communications and Knowledge Translation Officer
Centre for Health Evaluation and Outcome Sciences (CHÉOS)
PHC Medical Care Team Member