Study Says Heroin Better Than Methadone for Treating Addiction
A new study suggests that people who are prescribed heroin to treat opioid addiction are more likely than those given methadone to stay in recovery programs and are less likely to pursue illicit drugs or other illegal activities.
Almost 90 percent of the addicts who were given heroin remained in treatment in a follow-up analysis one year later, compared with 54 percent of those who were given methadone, according to a study in the New England Journal of Medicine.
Elizabeth Lopatto of Bloomberg.com reports that the heroin-treated addicts’ spending on illicit drugs dropped to $320 a month, compared with $400 in the methadone group, from the $1,200 a month they spent on drugs before treatment.
The paper explains that about 15 to 25 percent of opioid addicts don’t have a good response to methadone, which is the most common treatment for heroin addiction. European studies have suggested that prescribing pharmaceutical heroin may help those patients who are most resistant to treatment.
“The whole idea is that if you get them into this clinic, and they sit there a couple times a day and are in contact with health-care providers, it’s more likely they’ll have benefits,” said study author Martin Schechter of the University of British Columbia’s School of Population and Public Health. “The longer you can keep someone in treatment, the better.”
Heroin, as prescribed in the study, was less convenient than the pill methadone. It was injected three times a day by health-care workers, Schecter said. The maximum allowed dose was 1,000 milligrams a day, and the average dose was less than half of that. The dosage didn’t increase over time, Schecter said.
All participants in the study had failed at least two previous attempts at treatment, the research article said. At least one of those treatment efforts used methadone. Of 115 people prescribed heroin, 101 remained in treatment after one year. Of the 111 participants given methadone, 60 were still in treatment at that time.
The most common side-effects related to treatment with heroin were overdoses and seizures, and 16 of the 115 patients assigned to heroin experienced life-threatening events from these problems, the study said. All the patients recovered, since they were closely monitored by health-care staff.
The number of days the addicts illicitly used heroin dropped to five a month from 27 a month in the heroin-treated group, according to the study. The days the methadone group used heroin dropped to 12 from 27 a month. The two groups showed no difference in their additional illicit use of cocaine. Heroin users sometimes use cocaine and heroin together, in a concoction known as a speedball.
Heroin treatment was more expensive than that for methadone, but it’s still cheaper than unchecked addiction, Schechter said. An untreated heroin addict in Canada is estimated to cost about $50,000 a year, from use of the medical and criminal justice systems. Medicinal heroin costs about $5,000 to $10,000 a year, Schechter said.
The U.K.’s National Treatment Agency for Substance Misuse recommends that injectable heroin be considered only for the minority of patients who aren’t helped by oral methadone. Switzerland and the Netherlands allow prescription heroin for addicts, according to the editorial accompanying the study.
Germany and Spain don’t authorize the use, wrote Virginia Berridge, a professor at the London School of Hygiene and Tropical Medicine and the author of the editorial. The U.S. banned the drug in 1924, when Congress passed the Heroin Act.
The study also included 25 patients taking hydromorphone, also known by its brand name Dilaudid. The drug, approved by the FDA to treat severe pain in cancer, surgery, trauma and cardiac victims, appeared to work as well as heroin, though there weren’t enough patients in the sample to achieve statistically significant results. Future studies may examine Dilaudid for treatment abuse, Schechter said.
“I don’t think Dilaudid would be as unacceptable as heroin to most people in the U.S.,” he said.
