The best way to treat some heroin addicts may be to give them pure, pharmaceutical heroin, a new study argues.
The study, by Canadian researchers, found that injections of prescription heroin were more effective in treating longtime addicts than methadone, the most widely used treatment. Compared with addicts in the study who got methadone, those who received heroin were more likely to stay in treatment. Experts say lengthy treatment is often needed to treat other diseases as well as provide counseling to reverse criminal behavior and otherwise stabilize addicts' lives and improve the chances that they will stop using heroin.
All of the participants had tried treatment with methadone, which some addicts used for years, at least once and failed. Researchers said the point of using heroin as an alternative wouldn't be to immediately get addicts to stop taking the drug and didn't attempt to measure how soon heroin users in each group might be able to kick the habit. Rather, it would be to get them in to see doctors regularly and reduce their use of street drugs and the commission of other crimes. As with methadone, it would be up to the addict and his doctor to determine when and if he was ready to be weaned off the heroin by gradually taking smaller doses.
The new findings — published online Wednesday by the New England Journal of Medicine — are in line with those from similar recent studies conducted in Germany, Switzerland and other European countries. But they are unlikely to have any immediate impact on treatment in the U.S. since heroin is an illegal drug with no federally approved medical uses.
Experts say any change in the drug's status, even for medical purposes, is unlikely. "Politically it would be very difficult to get any kind of support to do it," said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, a professional group. Opioids are a class of drugs that include heroin and prescription narcotics such as OxyContin. Mr. Parrino wasn't involved with the study.
Experts say just conducting a clinical trial involving heroin in this country would involve getting special permission from the U.S. Drug Enforcement Agency and the Food and Drug Administration. U.S. researchers who had hoped to take part in the new Canadian study had to drop out because they had difficulty getting such permission and funding, said Martin Schechter, one of the study's co-authors.
In the U.S., heroin addicts are typically treated with methadone or other drugs and also provided with other services if they want them. Thomas Jefferson University Hospital in Philadelphia, for instance, has a program called My Sister's Place that specializes in providing long-term residential care for female addicts. The hospital also offers family therapy, obstetrical care, methadone treatment and nursery services for infants who exhibit signs of withdrawal.
The Canadian study, which lasted for 15 months, involved 251 longtime addicts in Montreal and Vancouver. All were over 25 years old and had been using heroin for at least five years. Participants had all been treated at least twice for their addictions, including once with methadone, a treatment that some addicts take for years to try to control their heroin cravings.