New York Times
August 20, 2009
Study Backs Heroin to Treat Addiction
By BENEDICT CAREY
The safest and most effective treatment for hard-core heroin addicts who fail to control their habit using methadone or other treatments may be their drug of choice, in prescription form, researchers are reporting after the first rigorous test of the approach performed in North America.
For years, European countries like Switzerland and the Netherlands have allowed doctors to provide some addicts with prescription heroin as an alternative to buying drugs on the street. The treatment is safe and keeps addicts out of trouble, studies have found, but it is controversial not only because the drug is illegal but also because policy makers worry that treating with heroin may exacerbate the habit.
The study, appearing in the current issue of the New England Journal of Medicine, may put some of those concerns to rest.
It showed that heroin works better than methadone in this population of users, and patients will be more willing to take it, said Dr. Joshua Boverman, a psychiatrist at Oregon Health and Science University in Portland.
Perhaps the biggest weakness of methadone treatment, Dr. Boverman said, is that many patients dont want to take it; they just dont like it.
In the study, researchers in Canada enrolled 226 addicts with longstanding habits who had failed to improve using other methods, including methadone maintenance therapy. Doctors consider methadone, a chemical cousin to heroin that prevents withdrawal but does not induce the same high, to be the best treatment for narcotic addiction. A newer drug, buprenorphine, is also effective.
The Canadian researchers randomly assigned about half of the addicts to receive methadone and the other half to receive daily injections of diacetylmorphine, the active ingredient in heroin. After a year, 88 percent of those receiving the heroin compound were still in the study, and two-thirds of them had significantly curtailed their illicit activities, including the use of street drugs. In the methadone group, 54 percent were still in the study and 48 percent had curbed illicit activities.
The main finding is that, for this group that is generally written off, both methadone and prescription heroin can provide real benefits, said the senior author, Martin T. Schechter, a professor in the School of Population and Public Health at the University of British Columbia.
Those taking the heroin injections did suffer more side effects; there were 10 overdoses and six seizures. But Dr. Schechter said there was no evidence of abuse. The average dosage the subjects took was 450 milligrams, well below the 1,000-milligram maximum level.
About 663,000 Americans are regular users of heroin, according to government estimates. The researchers said 15 percent to 25 percent of them were heavy users and could benefit from prescription heroin. That is, if they ever were to get the chance. Heroin is an illegal, Schedule 1 substance, meaning it has a high potential for abuse and serves no legitimate medical purpose. That designation is unlikely to change soon, researchers suspect.
In an editorial with the article, Virginia Berridge of the London School of Hygiene and Tropical Medicine concluded, The rise and fall of methods of treatment in this controversial area owe their rationale to evidence, but they also often owe more to the politics of the situation.
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