Tuesday, August 25, 2009

Heroin for Heroin Addiction

Getting your fix at the doctor’s office.

A group of Canadian researchers has demonstrated the truth of a practice commonly used in European countries like The Netherlands and Switzerland: Heroin can be an effective treatment for chronic, relapsing heroin addicts. Published in the New England Journal of Medicine, the study is “the first rigorous test of the approach performed in North America,” according to a New York Times article by Benedict Carey.

In the study, 226 patients were randomly assigned to oral methadone therapy or injectable diacetylmorphine, the primary active ingredient in heroin, over a 12-month period. The “rate of retention in addiction treatment” was 88 percent for the diacetylmorphine group, compared to 54 percent for the methadone group. The “reduction in rates of illicit-drug use” was 67 percent for the heroin group and 48 percent for the methadone group.

Using doctor-prescribed heroin has two advantages, some researchers believe. It gets around the problem of addicts who don’t like the effect of methadone and therefore don’t take it as prescribed. Moreover, as European countries have demonstrated, it brings treatment-resistant opiate addicts into regular contact with physicians and medical treatment professionals, thereby keeping them away from drug dealers and out of jail.

The downside is equally obvious. It keeps addicts hooked on heroin, and may even exacerbate their addiction by providing a higher quality drug. Furthermore, it runs against the prevailing North American notion that heroin should be illegal, period. Certainly, doctors have no business prescribing it to active addicts, critics argue. Furthermore, the risk of overdose or seizure is always present.

According to senior author Martin Schechter of the University of British Columbia’s School of Population and Public Health, as quoted in the New York Times: “The main finding is that for this group that is generally written off, both methadone and prescription heroin can provide real benefits.”

In an editorial accompanying the journal article, Virginia Berridge of the London School of Hygiene and Tropical Medicine cautioned that “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.”

At the end of the 19th Century in America, opium was widely prescribed as a cure for alcoholism. For opium addiction, the treatment was often alcohol.

Photo Credit: www.steps2rehab.com


Anonymous said...

I believe there was similar research carried out in Britain during the 60's outcomes of which were lower crime rates and more heroin users living healthier lifestyles. In turn this was reflected in savings to the N.H.S. with less illegal heroin related health problems.

Dirk Hanson said...

Yes, the British were on this early, and were pushing hard for this. I don't know exactly what British heroin policy is like these days.

Anonymous said...

This is obviously the answer. I'm not sure what the point of more "studies' is at this point. Isn't there enough positive data already from the Swiss HAT experiments?

rob said...

British doctors were barred from prescribing Heroin to addicts at the end of the '60s. The number of addicts ballooned after this, for a number of reasons. There are localised treatment programmes where addicts are prescribed heroin (there was one in the early '90s where addicts were given crack cocaine, believe it or not), but as a whole, Methadone or, more recently, Buprenorphine.

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