Let them take heroin, study says

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.

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

Comments

[Big Jim Slade]

Sorry, I've been to Zurich and seen all the junkies... Trying to paint this as a good thing is absurd.

Not exactly my idea of a perfect society. Then again they do control their immigration rather strictly in Switzerland.

[micki]

I am a recovering herion addict with 8 years clean & sober. I used herion 15 years. I also used and methadone for a number of years for treatment of my addiction and also abuse it. From my own experience I can tell you it's a lie that methadone blocks the effects of herion, for me it actually inhanced it with the right combination. Also a lie that methadone does not get you high. Lets consider the growing tollerence to these types of drugs and the cost to maintain a growing habbit before deciding it's more cost effcient to feed the disease than to treat it. To give a herion addict herion or methadone to keep them from commiting crimes is like putting a band aide on a shotgun wound. Addiction is a progressive and potentially fatal mental illness disease. There is no cure but there is hope for remission with abstinence through treatment of the disease.

[micki]

In reading over the comments posted, I am shocked at the ignorence well intended or not posted about the findings of this study of herion addicts. Addiction is a mental illness disease, and the criminal behaviors and character defects of addicts are there symtoms. If we are to get any relief from effects on society caused by addiction, then we must treat the disease not feed it! And we must educate everyone on the nature of the disease and how enableing the addict by giving them unlimited usage of drugs will only make the problem worse. A addict can not control there use and therefor will not be able to function in the work place and at home with unlimited use.

[evelyn]

is it okay to take methadone if you are still doing herion my son is i need to now also i need to find some recovery houses for him he is really verbilly agressive towards me and it is starting to scare me

[helena carleton]

for Evelyn and her son - the answer to your question is no, it is not safe to combine methadone and heroin . even more potentially dangerous is the use of methadone and benzodiazapines (oops)- in large amounts, combined with alcohol. I would recommend choosing one or the either heroin or methadone. Do not make your choice lightly - depending on the intensity and length of time he has been using heroin everyday matters. Methadone can become a life long tether for good or bad- do not choose it unless you truely understand this.
having said this I wish you both the best. Using methadone as tool for a short term detox ( 6 months to a year) is not recommended - in my experience.