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Medical Heroin Helps Treatment-Resistant Addicts
Date:8/19/2009

Controversial approach cuts 'street' drug use and illegal activities, study finds,,,,

WEDNESDAY, Aug. 19 (HealthDay News) -- Long-term heroin addicts who were given "medical heroin" were able to stay in treatment longer than those given methadone, a Canadian study has found.

In addition, rates of illicit drug use and illegal activity declined among the participants, who had failed earlier attempts at treatment, according to the study.

"Without [medical heroin], these people who've already been written off as beyond help would be on street drugs, exposing themselves to harms like overdose, HIV and illegal activities," explained the study's senior author, Dr. Martin Schechter, a professor and director of the School of Population and Public Health at the University of British Columbia. "But, if we can get them into a clinic while keeping them safe and stabilizing their lives, we can get them out of that 24-hour cycle and get them in touch with people like doctors and nurses."

"Sooner or later, they may seek counseling and other treatments," Schechter said. "And, in the meantime, you're saving a lot of money in health care because the treatment is far less expensive to the community than the alternative."

As many as a million people in North America are addicted to opioids, and the majority of them are addicted to heroin, according to background information in the study, which is in the Aug. 20 issue of the New England Journal of Medicine.

Methadone is a standard treatment drug given to replace heroin. However, about 15 to 25 percent of people addicted to heroin don't have a good response to methadone, according to the study. In some European countries, researchers have examined the use of injectable medical heroin -- diacetylmorphine, the active ingredient in heroin -- to treat addicts who've failed other treatment options. In the United Kingdom, it's recommended that medical heroin be used as a treatment of last resort.

The Canadian study sought to examine a North American population, though the authors acknowledged that the study could not have been conducted in the United States because of "financial and logistical barriers."

The study involved 251 people, all older than 25, who had been using opioids for at least five years and were currently injecting opioids daily. By random assignment, oral methadone was given to 111 participants, 115 were given medical heroin injections and 25 were given injections of hydromorphone (Dilaudid), a narcotic medication that has similar effects to medical heroin.

Almost 88 percent of those in the medical heroin group stayed in the study, compared with 54 percent of the methadone group. The reduction in the rate of illicit drug use or other illegal activities was 67 percent in the medical heroin group and 48 percent in the methadone group.

Ten people overdosed, none fatally, during the study period, and six people had seizures. Because of those risks, the authors wrote, medical heroin should only be used in a setting where prompt medical interventions are available.

On the whole, Schechter said, the approach is one worth considering.

"People need to have an open mind when it comes to the treatment of addiction," he said. "This treatment is good for the people addicted to heroin and very good for the community. It saves money and gets rid of black market criminal activity."

Though medical heroin is not likely to be approved for addiction treatment in the United States, Schechter said, the study did find that hydromorphone had similar advantages and is already approved for use in the United States. However, the study did not include enough people in the hydromorphone group, he said, so more research is needed.

An addiction medicine specialist, Dr. Joshua D. Lee, a professor of medicine at New York University Langone Medical Center in New York City, described the treatment as a "potentially effective approach to managing long-term heroin addiction" that has not responded to other treatments.

"While this doesn't get them off heroin, you're taking a potentially unsafe, toxic thing -- the package from the dealer down the street -- and you're putting it in a clinic setting where there's support if someone overdoses," Lee said. "It could kill the street drug trade and cause positive effects in the neighborhood."

"Methadone is life-saving for some people, but some long-term users just aren't interested in methadone, and it's a real public health problem," he added. "We have to develop alternatives to methadone maintenance."

More information

The U.S. National Institute on Drug Abuse has more on heroin addiction.



SOURCES: Martin Schechter, M.D., Ph.D., professor and director, School of Population and Public Health, University of British Columbia, Vancouver, Canada; Joshua D. Lee, M.D., assistant professor, medicine, New York University Langone Medical Center, New York City; Aug. 20, 2009, New England Journal of Medicine


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