Heroin Better Than Methadone for Treating Addiction

By chillinwill · Aug 20, 2009 · ·
  1. chillinwill
    OTTAWA — A Canadian study that found giving heroin to hardcore drug addicts at a supervised clinic leads to a higher rate of recovery than giving them methadone was published Thursday in the prestigious New England Journal of Medicine.

    The study, titled North American Opiate Medication Initiative (NAOMI), studied whether heroin-assisted therapy benefits people who suffer from opiate addictions. The study was released in October 2008, but was not published until Thursday.

    The NAOMI report concluded that injecting addicts with diacetylmorphine, the active ingredient in heroin, was more effective than oral methadone.

    Canadian scientists monitored 251 drug addicts in Montreal and Vancouver, the two cities with the largest heroin-addicted populations in Canada. The participants got drugs for 12 months under the supervision of nurses, doctors, psychiatrists and social workers.

    During the trial, 115 addicts received the medical heroin, 111 received methadone and 25 received hydromorphone — a licensed opiate for pain relief — starting in March 2007.

    The study found that those on the diacetylmorphine had an 88 per cent better chance of kicking the habit, compared to 54 per cent in the methadone group. Further, the reduction in rates of illicit-drug use or other illegal activity was 67 per cent in the diacetylmorphine group and nearly 48 per cent in the methadone group.

    Dr. Martin Schechter, one of the lead researchers of the study, said the publication of their work "feels like a vindication" of the criticism the study has received. One such criticism was speculation that addicts may report false results to increase their chance of more free drugs in the future.

    "The New England Journal of Medicine is one of the most prestigious journals in the world and it's a validation of the quality of the scientific work we have done," he said. "It puts the best seal of approval on a study and that does have an affect on policy-makers."

    Schechter said an editorial in the journal points out that giving addicts heroin is not a new idea and that the method has resurfaced in Europe and now North America.

    Following NAOMI, a further study was announced in June called SALOME — Study to Assess Longer-term Opioid Medication Effectiveness. Schecter, who will be also involved in that study, said they are currently trying to secure funding for the project. The SALOME will give more than 200 addicts in Montreal and Vancouver heroin treatment in pill and injectable forms.

    With the new study, scientists hope to prove that hydromorphone is just as effective as prescribing heroine to treat addicts. Schechter said the addicts given the hydromorphone could not tell the difference from heroin.

    "It would be effective where heroin is a non-starter because of political reasons, for example (in) the United States where they would use a licensed opiate for pain," he said. "If we could prove this, then it could be licensed for addiction."

    In the editorial in Thursday's Journal, Virginia Berridge says the findings of the Canadian study are widely supported in Europe, but have not been in the United States. The Australian government discontinued a heroin trial in the 1990s.

    "The results of this trial may be added to those from Germany, the Netherlands, Spain and Switzerland," Berridge said. "Switzerland has 10 years of experience in the prescription of heroin, and in a November 2008 referendum, 68 per cent of voters were in favour of its continued prescription."

    Meantime, the Harper government opposes Insite, a Vancouver-based facility that allows drug users to inject heroin and cocaine under medical supervision, and is embroiled in a legal battle to shut it down. The site, which opened in 2003, is supported by local and provincial governments.

    The federal government argues money should not be spent on drug use, instead directing funds toward prevention and treatment of substance addiction.

    By Tiffany Crawford
    August 19, 2009
    Canwest News Service

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  1. missparkles
    If this treatment works then it's not drug use, it's harm reduction and treatment, isn't it?

  2. dyingtomorrow
    SWIM doubts they will have these heroin clinics in the U.S. even within the next decade. But his big hope is for hydromorphone as a treatment alternative. He could stay off heroin and get his life together if he could get some injectable hydromorphone.

    Thanks for posting this chillinwill.
  3. Helene
    Swim found this article on the net earlier today, she was gonna post it up here but was beaten to it by swi-Chillin Will!!

    Swim was pleasantly surprised to read a positive, realistic heroin-related article in the press, (especially one addressing the subject of prescribed heroin) as opposed to the usual reams of scare-tactic, anti-drug propaganda.

    Seems like these Canadian scientists are rather clued up on the realities of heroin addiction, and the vast potential for treatment to be found in controlled prescription of diacetylmorphine. Hopefully their government (and others) will be brave enough to accept (and eventually even implement) the results of this study.

  4. missparkles
    Sparkles has been thinking about this a lot lately, and it seems that people who decide policy for the treatment of addicts seem to forget that maintenance programmes (where an addict sticks at a comfortable dose) are as important as getting addicts to quit.
    Sparkles knows quite a few addicts who pick up Methadone once a week who hold down a responsible job. They come from all walks of life and some are dealing with quite stressful, high powered occupations. They will never quit, their lives are ok as they are now, shouldn't they be offered something less punishing (which it is) than Methadone.
    Perhaps if an addict can show that they're not just wanting to get a purer buzz at the taxpayers expense, but can actually get their lives back on track, they should be offered alternative means of treatment?
    It wouldn't have helped Sparkles, she just wanted to get wasted, she freely admits this, any purer drug would possibly have been seen by her as condoning her using, and she would have used that as a reason to continue. A bloody good justification she supposes.
    Methadone is used because it stops the high, just keeps an addict comfortable, it's ideal for quitting, not for maintenance.


    More insane ramblings from Sparkles addled "paint fumes" brain.:laugh:
  5. Piglet
    In the UK, in addition to methadone, we use Buprenorphine (seems more effective than methadone) and, on occasion, dipipanone (although addicts have to visit the clinic twice daily) as well as morphine. For patients refractive to other therapy, specialists are allowed to supply 'dry amps' of diamorphine (heroin hydrochloride) and plain 'wet amps' of morphine and methadone. For people reducing their habit, specialists usually do this:

    1-Stabilize patient (using agonist)
    2-reduce dose
    3-switch to buprenorphine (for users on less than 80mg daily)
    4-switch to dihydrocodeine (for users down to 25mg or lass daily)

    In addition, for those who want to reduce quickly, specialists sometimes use a alpha2 adrenergic agonists such as lofexidine (Britlaflex) or clonidine.

    Once a user gets clean, long-term naltrexone (including inplants) are available.


    PS diamorphine comes as dry amps because in solution it breaks down to plain morphine and acetic acid. dry amps come as 5,10,30,100 and wait for it, 500mg amps. It also comes as tablets for dissolution & injections. These are referred to as 'jacks' and are 10mg each. The price in the BNF for 'jacks' is £12.92 per 100 (i.e. for a gram!)
  6. missparkles
    Sparkles used to be a patient at the Richmond Royal Clinic in the 70s-80s and used to get diamorphine amps and jacks (where the term "jacking up" comes from). She knows that they're still available but doesn't know any doc (apart from a couple of private ones) who are prepared to prescribe these.
    She certainly thinks it would be preferable to Methadone in some cases.
    She knows this is "off topic" but someone asked about Tuinal in another topic. They're still produced but rarely prescribed. She thinks it's the same for diamorphine. Sparkles had to be registered to get it.
    Take care.
  7. Spucky
    AW: Re: Heroin Better Than Methadone for Treating Addiction

    Do you really want to know why there is so much "positive PR"? :laugh:

    Not Heroin will safe an Addicted Person,
    either Methadone,
    it`s not the matter of Money,
    it is a matter of Ethic!

    (They will flush down us all!)
  8. Hollow Hippie
    Re: AW: Re: Heroin Better Than Methadone for Treating Addiction

    I really cannot understand what your point is.
  9. Spucky
    AW: Re: AW: Re: Heroin Better Than Methadone for Treating Addiction

    The Discussion about Heroin as a Substitute
    was one of the main Ethical question,
    in the same League like Clone-Therapy or Abortion!

    What will be happen if all the other Substitute Programs,
    all the Rehabs and Detox vanish because Heroin is sooo cheap
    and soooo successful?

    I don`t believe into a change for the better.
    Of course i welcome the possibility of a Heroin-Maintenance,
    but i hope it will be not the Main-Medicament!
  10. chillinwill
    Study Backs Heroin to Treat Addiction

    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 don’t want to take it; they just don’t 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.”

    August 19, 2009
    NY Times
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