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

addiction drugs

Heroin Overdose Kits: The Debate Goes On

More states back naloxone programs, but Feds aren’t convinced.

Since the first trial run in Chicago several years ago, efforts to provide heroin addicts with naloxone overdose kits has gained ground in Baltimore, New York, Boston, and several other cities and states. As reported here at Addiction Inbox last month, Dr. Peter Moyer, medical director of Boston’s fire, police and emergency services, applauded the recent Massachusetts decision to expand the Boston program to the entire state and offer Massachusetts heroin addicts the overdose reversal kit. Approved by the Food and Drug Administration (FDA) 35 years ago, Naloxone, or Narcan, is the standard emergency room treatment for heroin overdose. Naloxone instantly reverses life-threatening overdoses by crowding out heroin molecules at the brain receptor sites where they bind.

Predictably, the Office of National Drug Control Policy in the White House does not support the Massachusetts program. Drug Policy officials do not like the idea of addicts medically treating other addicts and have argued repeatedly against distribution of the naloxone kits, claiming that distributing the Narcan antidote will only encourage heroin use and delay treatment.

But the move among states and cities for direct naloxone distribution to addicts continues to gain momentum. In Baltimore, assistant commissioner of health Richard W. Matens maintains that the direct-to-addicts model had been “extremely successful” in his city. Death by heroin overdose reached its lowest level in a decade in 2005, and Matens says the naloxone distribution program played an important role in that reduction.

At the New York State Health Department, which oversees 20 naloxone distribution programs in New York City, Dan O’Connell told the New York Times (reg. required) that from a public health perspective, heroin overdose kits were “a no-brainer.” O’Connell, director of the department’s H.I.V. prevention division, said: “For someone who is experiencing an overdose, naloxone can be the difference between life and death.”

Wisconsin, Minnesota, Connecticut, New Mexico, Rhode Island, and several other states are also embarking on naloxone distribution programs. Thousands of lives are likely to be saved if the idea continues to gain ground.

So what could be the worm in the apple?

“It is not based on good scientific data,” contends Dr. Bertha Madras, deputy director with the White House Office of National Drug Control Policy, which continues its steadfast opposition to such programs. “It’s based on what some people would consider the right thing to do. But the studies supporting it are so sparse it’s painful.” As evidence, Madras and other federal substance abuse officials point to a survey of San Francisco drug addicts done in 2003, the year San Francisco first began funding naloxone distribution. About one-third of the addicts in the survey said they might use more heroin if they had naloxone to protect against overdose. “In the absence of scientific evidence,” Madras told the Times, “we don’t engage in policies that would bring more harm than benefit.”

However, a more recent survey of San Francisco addicts casts major doubt on those findings. In 2005, when the city began a trial program giving out two free needles loaded with naloxone, local officials claimed that fatal overdoses began to fall markedly, and city officials were soon claiming that heroin overdose deaths were at their lowest mark in ten years. California programs train addicts in the use and administration of naloxone. “I’m glad they’re showing us this stuff,” one addict said. “I don’t want to just sit there if someone ends up in a bad situation.”

According to figures reported by the Harm Reduction Coalition, 3,691 California drug users died of overdose in 2003, the latest year of official records. This represents an increase of 42 per cent since 1998, resulting in an annual death rate greater than that from firearms, homicides, and A.I.D.S.

But so far, states are on their own, as Federal drug policy officials continue to maintain that naloxone should only be prescribed and administered by doctors. And yet, many doctors refuse to treat heroin addicts, on the grounds that there is nothing that can be done for them, or that they are recalcitrant patients.

Dan Bigg, director of the Chicago Recovery Alliance, told the New York Times he has seen firsthand that such overdose kits are effective. “What we have here is an antidote to the problem [of heroin overdose],” Bigg said. “Now we just have to convince people it’s worth it.”

Overdose Kits for Heroin Addicts

Massachusetts to offer Narcan nasal spray

Noting that heroin overdoses kill more people in Massachusetts each year than firearms, Dr. Peter Moyer, medical director of Boston’s fire, police and emergency services, applauded the state’s decision to offer addicts an overdose reversal kit. The package contains two nasal doses of naloxone, known as Narcan, a drug that reverses heroin overdose and saves uncounted lives (many victims of heroin overdose never see a hospital) when administered quickly enough. “It’s a remarkably safe drug,” said Dr. Moyer. “I’ve used gallons of it in my life to treat patients.”

Predictably, other health authorities aren’t so sure. “You give them the Narcan, where is their motivation to change?” said Michael Gimbel, director of substance abuse for Baltimore County, Maryland. “Giving Narcan might give them that false sense that ‘I can live forever,’ which is not what we want,” he told the Associated Press. Although similar programs have met with success in Chicago and New York City, the Massachusetts program is not supported by the Office of National Drug Control Policy in the White House. Drug Policy officials do not like the idea of addicts medically treating other addicts. Other officials argue against distribution of the kits, as they have frequently argued against needle distribution programs—in the belief that distributing the Narcan antidote will encourage heroin use and delay treatment for addicts.

Almost no one disputes the fact that heroin is currently popular throughout New England due to low prices and a surge in demand. “It’s the perfect storm in all the wrong directions. We talk about availability, price and potency,” said Kevin Norton of CAB Health & Recovery Services, one of the state-designated Narcan overdose kit providers.

The state-sponsored overdose kits were first tried in a pilot program in Boston, where Public Health Commissioner John Auerbach decided to go statewide after the kits were used to save 66 overdoses in the Boston area. “Narcan’s been around for a long time,” according to Cindy Champagne, director of nurses at the Greater New Bedford Community Health Center. Nonetheless, Champagne expressed some reservations about the drug “being out there for addicts to use,” noting its powerful effects and the rapid reversal of overdose, which leaves some addicts “combative.”

But Joanne Newton of the Seven Hills Behavioral Health Center of New Beford, another of the administrators of the program chosen by the Massachusetts Department of Public Health (DPH) cautioned that the program is carefully regulated, and will not increase the likelihood of addict overdoses. “There will be protocols and policies,” she said. “We’ll have to see what DPH’s plan is.”