VOL 52: JUNE • JUIN 2006 Canadian Family Physician • Le Médecin de famille canadien 705 Editorials Why we object to NAOMI

Heroin maintenance is a controversial treatment for addicts who have not had success with metha-done treatment. A Swiss cohort study1 and a con-trolled trial in the Netherlands2 demonstrated that heroin injection programs improved health and social outcomes. The North American Opiate Medication Initiative (NAOMI) will attempt to replicate these findings in Canada. Similar in design to the Dutch trial,2 NAOMI will recruit 470 heroin addicts in Vancouver, BC; Montreal, Que; and Toronto, Ont. The control group will receive methadone; the intervention group will receive methadone and medically prescribed heroin, injected under supervision 2 to 3 times daily for 1 year. The heroin doses will then be tapered, and participants will be offered standard treatment; both groups will be followed up for an additional year. Investigators making the case for NAOMI point out that heroin addiction is associated with high morbid