Drug May Offer Alternative for Heroin Addicts

Study finds buprenorphine less addictive than methadone

THURSDAY, Feb. 20, 2003 (HealthDayNews) -- A new drug therapy for heroin addiction appears to offer patients relief and let them stay in a stable treatment program.

Swedish researchers found the treatment, buprenorphine, may be a better option than methadone for heroin users because it's less addictive, less toxic and effectively reduces withdrawal symptoms when coupled with a behavioral therapy program.

In this first placebo-controlled trial of buprenorphine, the team tested the drugs effectiveness in 40 patients. Half were randomly selected to receive a daily dose of the drug, while the remaining 20 subjects received a six-day withdrawal treatment followed by a daily dose of placebo.

One year later, the results were impressive. All of the patients in the placebo group had dropped out of the study, while three-quarters of the patients on buprenorphine remained in the treatment program.

"Previous studies with methadone treatment after a one-year follow-up showed that you tend to get a retention rate of about 50 percent. This is clearly a spectacular result compared to that," says lead author Dr. Markus Heilig of the psychiatric unit of Huddinge University Hospital in Stockholm.

The results appear in the Feb. 22 issue of The Lancet.

The trial was ethically complicated because the survival rate and clinical outcomes for heroin addicts are so abysmal; it was illustrated in this case by a 20 percent mortality rate among those who received the placebo. The researchers wrestled with the knowledge that by not giving 20 of the subjects a potentially beneficial therapy, the researchers could be denying them lifesaving treatment.

The team therefore chose to focus on patients who were not eligible for methadone treatment so that those who got the placebo were not prevented from receiving a readily available therapy. As a result, this study ruled out subjects with a long, documented history of addiction who would be best treated in a methadone clinic.

Both groups of patients were supported with very comprehensive behavioral and cognitive therapy, which included weekly counseling sessions and regular contact with medical staff. To determine how many patients relapsed, the researchers analyzed weekly urine samples from the subjects and discovered that while all of the subjects in the placebo group relapsed, only 25 percent of the patients receiving buprenorphine therapy did.

The findings are good news for addicts in the United States, who often struggle to get access to methadone treatment because the drug is tightly regulated and requires daily trips to a methadone clinic. Patients' difficulty in accessing methadone is further complicated by the drug's recent migration from treatment centers to the black market, where it's rapidly becoming a burden for drug enforcement agencies.

Buprenorphine appears to be less addictive, and when combined with another drug, naloxone, is unlikely to be abused as an illicit substance, Heilig says.

"Hopefully this will help bring addiction treatment back to mainstream medicine," says Joycelyn Woods, president of the National Alliance of Methadone Advocates. "Methadone has such a terrible reputation, so the hope is [with buprenorphine therapy] that people will be able to come into treatment earlier. You can get them before they get into a lot of trouble."

In light of these encouraging results, Heilig plans to explore the possibility of using a tapered dose of buprenorphine to help heroin-dependent patients eventually withdraw from drug treatment all together.

"This trial is likely to become a classic in the area. The results have far-reaching implications for the treatment of opioid dependence in general, and the role of psychological treatments and buprenorphine in particular," Fergus Law and David Nutt, from the University of Bristol, write in a commentary accompanying the study.

More information

Learn more about heroin from the National Institute on Drug Abuse. If you're hooked and want help, try the Addiction Resource Guide.

SOURCES: Markus Heilig, M.D., psychiatric unit, Huddinge University Hospital, Stockholm; Joycelyn Woods, president, National Alliance of Methadone Advocates, New York City; Feb. 22, 2003, The Lancet
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