Competence and Inequity Are Both Important to the Ethics of Supervised Injectable Opioid Assisted Treatment

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Notes

1. Note that the designs of the two clinical trials in question are different. The SALOME trial is “a randomized double-masked clinical trial designed to test the non-inferiority of injectable hydromorphone, a potent short-acting opioid licensed for analgesia, compared to injectable diacetylmorphine” (5). The Geneva trial involved a randomization to “immediate or delayed admission” (Perneger et al. 1998, 13). This difference affects the context and status of “voluntary consent” and access to injectable heroin in both mine and the authors' discussions.

2. It is interesting that in the preparation for the Geneva trial, Swiss lawyers who were consulted voiced concerns about consent and the capacity and legal accountability of patients enrolled in that trial to give voluntary consent (Sprumont 2002). But this did not stop the trials from going ahead, much like the SALOME initiative.