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Let them take heroin, study says

August 19, 2009 |  2:00 pm

To improve the chances that hard-core heroin addicts will stick with their treatment for opioid dependence and forgo the use of illicit drugs, they should take … heroin.

That’s the controversial conclusion of a study being published in Thursday’s edition of the New England Journal of Medicine.

Heroin The study focused on addicts who took heroin for at least five years and had already failed two attempts at treatment. One of those attempts had to involve methadone, which helps manage heroin cravings and blocks the drug’s euphoric effects.

The goal wasn’t necessarily to get study participants to stop using heroin altogether, but to turn their addiction into a manageable fact of life instead of a source of high-risk, illegal and/or anti-social behavior.

Canadian researchers randomly assigned 115 addicts in Vancouver and Montreal to receive diacetylmorphine – the active ingredient in heroin – and 111 others to a control group that got standard methadone treatment. Those who took diacetylmorphine injected themselves up to three times a day in treatment clinics with medical supervision. Then they had to remain in the clinic for 30 minutes so they could be monitored for overdoses, seizures and other serious problems.

Overall, the addicts who took diacetylmorphine did better than the ones who took methadone.

After one year, 88% of those in the diacetylmorphine group were still in treatment, compared with 54% in the methadone group. They were also more likely to curb their illegal behavior – including use of illicit drugs – by a margin of 67% to 48%.

Patients treated with diacetylmorphine also saw bigger reductions in their illicit heroin use. They had taken the drug for an average of 26.6 days in the month before the study started, and that number fell to 5.3 days by the end of the study. In the methadone group, illicit heroin use fell from an average of 27.4 days per month to 12.0 days per month during the course of the study.

The researchers also reported that addicts who were treated with diacetylmorphine “had greater improvements with respect to medical and psychiatric status, economic status, employment situation, and family and social relations,” according to the study.

One patient from the methadone group died of an opioid overdose during the 12-month trial. But overall, serious adverse events were more than 2½ times more common among the diacetylemorphine group. Sixteen of those participants experienced a life-threatening seizure or overdose; all received prompt treatment at their clinic and recovered. 

The researchers emphasized that most heroin addicts should continue to be treated with methadone. But when methadone doesn’t cut it, they concluded, “prescribed, supervised use of diacetylmorphine appears to be a safe and effective adjuctive treatment for this severely affected population of patients who would otherwise remain outside the health care system.”

That advice may sound radical, but it has already been followed in several European countries. Switzerland, the Netherlands and Great Britain currently treat some heroin addicts with diacetylmorphine, according to an editorial accompanying the study.

In the United States, only methadone has the imprimatur of a “medical” drug, writes Virginia Berridge of the London School of Hygiene and Tropical Medicine at the University of London. That bias may help explain why the Canadian researchers were unable to collaborate with their colleagues south of the border. Perhaps, Berridge speculates, the Canadian results will have more influence on American policymakers since the study was practically “homegrown.”

-- Karen Kaplan

Photo: Methadone helps many heroin users stay off the drug, but it’s not powerful enough for all addicts. Credit:  Los Angeles Times

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Comments (30)

Don't expect scientific studies to change U.S. drug laws. That would take common sense, something politicians don't have.

DUH - the group who did the best were getting the Herion fix - no need to take other drugs and since their fix was freeeeeeeeeeeeeeeeeeeeeeeeeeee 3 TIMES A DAY NO NEED TO COMMIT CRIMES EITHER - hope there wasn't any U.S. tax money put into this stupid silly so called study. Lock up the addicts in cell for however long it takes the body to rid itself of the poision and to readjust to being normal.

Free Health Care -

Free Mortgages -

Free Drugs -

WOW...ain't Obama Great!!!

There is no one more content and placid than a heroin addict that has had their fix.

We should offer treatment, and if that fails, or is ineffective, provide maintenance doses of heroin. The government has available product, and woudl be put to better use placating addicts, rather than destroying the drugs.

It has been proven outsie of the US as a viable strategy, and we should embrace it here.

The average American has no use for science, because science depends upon emperical evidence. The have no idea what they vote for

Average Americans prefer to shill for; drug companies, insurance companies, correction officers unions. While they get stomped by the same.


@rob and marlena - did you even bother reading the article? obviously not, and obviously both of you illiterate imbeciles are just looking for excuses to attack the president.

the study was conducted IN CANADA. there was NO COOPERATION FROM US SCIENTISTS, which means there was NO US TAX MONEY SPENT. the study looks at a time period of over one year (which means it was begun BEFORE OBAMA WAS PRESIDENT), oh, and in case you didn't get it the first time around, IT WAS CONDUCTED IN CANADA.

i'm so f'ing sick of ignorant, partisan for no reason other than fox news tells me to be partisan but i'm not going to even bother reading articles i comment on let alone actually doing research for myself or trying to formulate original thoughts people in this country. you and your ilk are precisely why things are such a mess amongst the citizens of america. ugh.

Finally the United States is finally catching up with there European counter parts in the war on drug addiction. Let them take heroin will not only keep these people from criminal activities but they will be able to function at a much higher level by leagaly getting the drug they are more apt to get jobs take care of there families instead of running and living like dogs in the streets because the street life style is what makes you socially unaceptable not the drug. The Drug helps them to function better once they are addicted. getting it leaglely will take the sticmma and shame out of this illness of addiction.

To Marlene Duuh thats the point of giving it to them. You are a real scientist

Wow these comments are strange. Rob somehow made this about Obama and Marlena thinks locking up addicts is an effective strategy. First, I'm not an Obama groupie, but this has nothing to do with him and second, our prisons are busting at the seams with drug addicts. The Europeans have lower drug use and don't treat addicts like criminals (to the same degree), but we love to make everything illegal and then expect people to simply follow the rules. Remember prohibition, it didn't work then and won't work now. Lets put aside our philosophical ideals and hard headedness and make smart logical decisions, even if the make us feel uncomfortable. We made gambling legal and it hasn't destroyed America, we've made prositution legal in parts of Nevada and they are going broke due to a lack of customers. The wold does not end when we simply think and act accordingly. I don't like gambling or prositution, but criminalizing them makes things worst.

'Rob R Barron' and Marlena - The study was funded by the Canadian government. Please read the article before you comment on it.

wow idiots that talk about people that are on drugs. you don,t realize that addicts need help. knowing this is very hard for idiots that talk more then they listen.your probably an addict yourself it may not be hard core drgs but it's alcohol. some of you's drink to get drunk and then drive home intoxicated so who really need to be in jail. also obama does not have this problem. Bush's daughter have this problem so if he allows his daughter to drink and be drunk then what example does he gives his daughters? so get your facts straight and stop trying to send addicts to jail. ask yourself if your ever saw an addict i mean SAW an addict under the influence of this drug and some live in this you may not see it these addicts disguise themself so no one knows .

did some of you read the article they are saying they can give help to some addicts for them not using herion thats what killing people.

For ten years, I had an open prescription for dilaudid, synthetic morphine, because of the extreme pain I suffered after injuries and surgeries to improve movement. I no longer need it. I don't understand why people who need a drug because of addiction can't have it, when I was permitted to control when and how much of an addictive drug I took, because of pain. As I got better, I decreased my use, until I recovered. I have a few pills incase of a flare up. Medication and a form of occupational therapy may make a difference for many addicts and is worth a try.

Heroin seems like the absolute worst drug to be addicted to. I continue to be amazed at people who think "I can control my usage and only partake once in awhile". The high is non-existent for a long term addict with tolerance. The only effect they get is keeping WD away. For that you pay hundreds of dollars a day? And whats with that Mex tar stuff? People actually inject that contaminated sh]t in their veins? Gracias Chiveros.

With all the heroin seized every year, the govt could set up dope camps out in the desert where addicts could fix to their infected hearts content. Sound cold hearted? Fine by me if it keeps junkies out my parks.

Many junkies will tell you that they've kicked heroin many times, but have never been able to kick methadone. It's an equally dangerous (if not more) drug, equally addictive, and as the study illustrates, less effective treatment, but it is accepted because it's "clinical." A relative of mine almost died due to liquid methadone (ingested by drinking rather than injecting), after using street heroin for years with no OD.

Anything to keep junkies from withdrawaling, is good. Because a junkie cannot function for WEEKS if they're withdrawaling from going cold turkey and now matter how decent of a person they are inside, they'll be treated like dirt from the appearance on the outside. I know from personal experience. They need to make treatment more available and methadone free, or we'll all be like this until we die. And I don't wanna die yet.

The reality is that many addicts can't (or at least won't) get off heroin and other opioids, and that's not going to change just because you wish upon a little star that things were different. We should take realistic measures to prevent their habits from harming them and the rest of society. The abstinence-only "tough on drugs" approach has been a failure for the past 40 years. It has resulted in a thriving black market for drugs, with all of the predictable accompanying violence (disputes over drug-selling turf), theft (to pay for artificially inflated drug prices), and drug impurities and adulterants (causing overdoses and poisonings). Abstinence-only, zero-tolerance approaches to society's drug problem are the equivalent of sticking our collective head in the sand, much in the same way as abstinence-only approaches to sex education.

All of these wild claims about the health risks of pharmaceutical-grade heroin are ludicrous. Heroin is no more dangerous than morphine at equianalgesic doses, and is no more addictive than many other commonly prescribed strong opioids; the main difference between morphine and heroin is that heroin takes effect more quickly, which is one reason that heroin is often prescribed in the U.K. for pain instead of morphine. The real health risks of street heroin come from (1) the dangerous impurities and cutting agents which do not exist in pharmaceutical-grade heroin like that prescribed in the study's clinic, (2) unsafe injection practices and needle reuse, which are not a factor in a medical environment like the study clinic, and (3) overdoses caused by widely varying potencies of street heroin, which are not a factor when administering regulated doses of pharmaceutical-grade heroin.

Moral indignation directed towards drug use and drug users has not worked so far, and there is no reason to believe that it ever will. If medically-supervised heroin or methadone maintenance produces no problems apart from the mere fact of continued drug use - if they reduce violence, poverty, theft, drug overdoses, and poisonings - then we ought to use these tools to finally start doing something realistic about our society's "drug problem."

I'd like prevention studies to keep people from using drugs. Are "cures" or "treatments" excuses for funding some more of these studies? The entire human care industry rarely focuses on prevention, there's no money in prevention. To the detriment of people, there's plenty of money in "cures" and 'treatments." There are medication for everything mental or physical. There's liposuction to medicinal marijuana, triple by-passes to angioplasties with stents, all quite profitable, but costly to our society. It's a national security issue, so we need our government to push for preventative measures. Yet, I'm sure the healthcare industry and conservative minded fear mongers will lobby against sending their agents yelling and screaming at town hall meetings. And, marijuana liberalization groups will justifying heroin as a "cure" which will generate billions in sales tax revenue.

You comments disgust me, did you read the article? Do you even know what you're talking about? You write: "Lock up the addicts in cell for however long it takes the body to rid itself of the poison and to readjust to being normal."

A friend of mine in college had a sister who became a heroin addict and the stories he told me were heartbreaking tales of a difficult struggle. Normal nice conservative middle class family that fell apart when the mother suddenly died and the daughter, after having survived cancer as a teen, became careless for her life and ended up with the wrong crowd.

He and his father tried the "lock em up for however it takes" approach with her and from what he told me it must have been one of the most horrific experiences ever for them. Really bad. It wasn't their daughter/sister anymore. Only with a long supervised therapy which included things like methadone they were able to "get her back". Lost track of him, so I hope it worked out for his sister in the long run.

I'm not defending drug use here, some addicts are to blame themselves but others need serious help not self-righteous comments.
Unfortunately the simple mind likes the simple solutions...

We'd have a far better society if we made drugs legal and instead locked up fools like Rob and Marlena.

makes perfect sense in every way. this is a real solution

If the drug problem is remedied by treatment/prevention rather than incarceration, then big government would have to eliminate many jobs (you know how well that will go over). With 75% of the prison population related to drug use, and the U.S. incarcerating more people than any other country than CHINA, I would say it is safe to say criminalizing drug use has FAILED and will continue to fail. How long does it take to figure that out?

First and foremost you have to control the borders (national security issue because of the criminalization that comes with drugs). Next, and at the same time you need to begin treating those with problems and educating those in school about the risks/consequences. Our society puts the burden on parents to do what schools can't do (keep drugs out), but as we know parents have lost authority with their kids and kids are getting into trouble more than ever before. More education and treatment is necessary and drugs need to be less criminalized. After all, these people are doing this to themselves just as they ingest alcohol and smoke cigarettes and eat highly saturated fatty foods.

To those that criminalize it, almost all of Congress and many of your presidents should have been in prison and probably you as a youngster and your kids....give me a break and get real....

You got an education use it...and lets de-criminalize something that is breaking our prison system and society. I mean we are doing so "well" that only CHINA is "worse" than us!!!

The fact remains that nobody can force a drug dependent person to stop using. No amount of "Locking them up until they get rid of the poison and get back to normal" will work - because the physical dependence is only the beginning. Its the emotional dependence that keeps coming back to tempt you - years after your last shot of heroin.
I've been on a methadone program for more than a decade. I'm a functioning member of society in a responsible job. I pay my taxes, I vote and I don't break the law. However, many years on methadone have left me completely and utterly physically dependent on it. Methadone is TEN TIMES more addictive. If I were to stop using it tommorow - the really bad withdrawals wouldn't even start for a week. I would have excruciating back, leg and joint pain, vomiting, bowel problems, shakes, headaches and extreme anxiety. Add complete insomnia to the list. To those of you who've never had to go through it - remember that really really bad flu you had? Its a bit like that - only it lasts for months. I'm just not brave enough to put myself through this at this time.
However, if I had access to heroin, the withdrawals would be much more manageable - and I would be much more likely to become drugfree - which is my eventual goal.
This is all pie in the sky anyway - it ain't gonna happen. Too many people make too much money out of heroin being completely illegal for it to ever change - even in a registered medical program for a limited number of people.


Think of all the money the US could raise if we legalized drugs, and taxed them! We could make tax income on the billions of dollars made in the illicit drug trade, have quality control of the product (and offering drug counseling or treatment with funds from sales), and the reduction in violence due to the fact that people do not have to commit crimes to get there drugs. Its not a perfect plan but sounds like a win / win proposition to me! If you cant beat them, join them!



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