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From Opium to SALOME…

3100 BC: Sumerian ideogram denotes opium poppy as ‘plant of joy’.

1552 BC: A papyrus advises Theban physicians on the use of opium in 700 different concoctions including one for sedating troublesome children.

1580: English form relations with Ottoman empire and discover opium dens.

1600’s: the Portuguese and the Dutch begin to trade opium in China.

1600's: European traders bring tales of opium; chronic opium consumption amongst groups of turks, arabs and parseans.

1600's: In Europe opium is taken in medical context but dependence is common.

1753: Swedish Botanist Carl von Linne (1707-78) terms the individual specie of poppy that is associated with opium Papaver somniferum, meaning sleep-inducing poppy.

1763: British traders asserted its opium monopoly in India and excluded native, Dutch and French merchants who previously bought opium in competition.

1790: In China opium use was fashionable for rich youths, young clerks and government officials.

1799: China gives imperial proclamation to prohibit the importation of opium throughout China.

1800: Opiate use in Europe was still considered medicinal while drug subcultures were imagined as part of Islamic society. Opium prescribed more often to women as a way of regulating their feelings and containing their behavior.

1806: Morphine is first discovered.

1836: Peking orders expulsions of opium-importers. Conflict leads to the Chinese Opium wars.

1848: The hypodermic needle is developed, and morphine starts to be injected.

1874: C.R. Alder Wright boils Morphine with acetic anhydride to form diacetylmorphine, or Heroin.

1875: San Francisco passes the first ordinance against opium shops. Over the next 15 years eleven western states establish legislation to criminalize users as opposed to regulating the substance.

1898: Bayer first markets heroin as a cough relief.

1898: Bayer first markets heroin as a cough suppressant.

1898: The typical morphine addict in Britain or the US was a middle-class woman in her forties.

1906: The American Medical Association approved heroin for medical use.

1908: Canada passes Opium Act of 1908 prohibiting importation, manufacturing and sale of opium.

1912: The International Opium Convention at the Hague is the first international agreement to suppress the non-medicinal use of heroin, morphine and cocaine.

1913: Bayer stops making heroin.

1915: The Harrison Act is passed in the USA further restricting narcotics and cocaine and was the foundation of federal controls in the USA until 1970.

1926: In Britain, medical prescription of opioid drugs, including heroin, to addicts was officially sanctioned on the recommendation of the Rolleston Report.

1930: Henry Anslinger becomes first Drug Czar of the USA until 1962. Anslinger worked tirelessly to vilify drug users as evil.

1960: The UK restricts the prescription of heroin for opioid dependency.

1961: The Single Convention on Narcotic Drugs treaty is signed by many countries including Canada and the USA.

1963: Halliday describes the use of methadone for the treatment of heroin dependency in the British Columbia Medical Journal.

1965: Dole & Nyswander publish their trial on methadone for heroin dependency in the Journal of the American Medical Association.

1970: Nixon declares ‘war on drugs’ - the Controlled Substances Act of 1970 is passed. Heroin is categorized as Schedule I drug meaning heaviest punitive control.

1972: In Canada, "Le Dain Commission" (Commission of Inquiry into the Non-Medical Use of Drugs) recommends: "Treatment units should be able to resort to [heroin maintenance] as a transitional measure to attract from the illicit market opiate dependents who will not respond to methadone".

1973: In the USA, Koran supports heroin maintenance treatment, publishing in the New England Journal of Medicine: "Carefully designed clinical research on the safety and efficacy of heroin maintenance should be undertaken, particularly with addicts not helped by current treatments".

Mid-1980's: The HIV/AIDS epidemic in the mid- to late- 1980s shift opioid maintenance prescribing as an intervention that could reduce the harm from injecting drug use.

1990's: Open heroin injection drug scenes in urban settings. Heroin becomes a major public health problem.

1994: Switzerland opens the first supervised heroin-assisted treatment (HAT) clinics, where injecting heroin users can go and receive the drug on site, under medical supervision.

1999: The WHO expert panel report on the Swiss experiment recommends more randomized clinical trials.

2002-2010: The Netherlands, Spain, Germany, Canada and the UK publish the results of studies showing heroin is more effective than oral methadone on people not benefitting from treatment.

2007: Health Canada disallows compassionate use of heroin for those study participants that responded to treatment. Canada will be the only country that has ever terminated the treatment after showing success. The Canadian study team applies for research funding to continue investigating effectiveness of licensed injectable opioids (the SALOME trial).

2008: Providence Health Care (PHC) takes over the injectable clinic in the Downtown East Side in Vancouver (now called the Providence Crosstown Clinic), awaiting to start the SALOME trial.

2009: The Canadian Institutes of Health Research approves a trial comparing heroin and a licensed pain killer, hydromorphone. The SALOME team applies for an exemption 56 in order to import the heroin for the study.

2010: Denmark starts heroin maintenance programs.

2010: Heroin is registered for opioid maintenance treatment in the UK, Switzerland, The Netherlands, Germany and Denmark.

2011: In July, SALOME obtains all the required approvals to start the study.

2011: In December, SALOME begins.

2013: PHC doctors start applying to Health Canada for special access for participants of SALOME when they finished their 12-month study.

2013: In October, Health Canada approves 21 patients through its special access programme to continue to use diacetylmorphine.

2013: In October, within days of the special access programme approvals, Rona Ambrose, Canada’s Minister of Health, announces that the Harper government is making immediate changes to ensure diacetylmorphine was no longer eligible for authorization for individual patient use.

2013: In November, PHC and five SALOME patients launch a constitutional challenge in the BC Supreme Court requesting, among other things, a declaration that the new federal government regulations infringe Charter rights, are unconstitutional, and should be struck down.

2014: B.C. Supreme Court Grants injunction allowing doctors at PHC to continue prescribing diacetylmorphine to SALOME participants.

2015: In late 2015, SALOME concluded.

2016: In April 2016 SALOME was published in JAMA Psychiatry