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Heroin Use Leaves Trail of Troubles

Study follows 33 years of addiction, suggests early treatment

FRIDAY, May 18, 2001 (HealthDayNews) -- The toll of long-term heroin use is tremendous, and staying clean is almost impossible, a 33-year study has found.

"Early intervention to stop addiction is really the key to stop the cycle of relapse. Recovery for some people is a lifelong process," says study co-author Yih-Ing Hser. "I think that a cure, in terms of abstinence, is really unrealistic. The brain has been changed with addiction."

Hser and her colleagues at University of California at Los Angeles (UCLA) say treatments should start early and focus on small victories.

"With the involvement of the criminal justice system, we can catch addicts much earlier in their careers," says M. Douglas Anglin, study co-author and director of the UCLA Drug Abuse Research Center. When judges order treatment for first-time offenders, the results are much better, because most other addicts have used drugs for eight to 12 years before they seek treatment on their own, he says.

The study, published this week in the Archives of General Psychiatry, included a third look at 242 of 581 male heroin addicts admitted to the California Civil Addicts Program in the early 1960s; 284 addicts in the original program had already died. The median age of the addicts this time was 57.4 years. Of those left, 20.7 percent tested positive for heroin use, 9.5 percent refused testing, and 14 percent were in prison and couldn't be tested.

The bad news didn't stop there.

Tobacco use was reported by 66.9 percent, while 22.1 percent said they drank alcohol every day. Of the many who reported illegal drug use in the previous year, 40.5 percent had used heroin, 35.5 percent had used marijuana, 19.4 percent had used cocaine, 10.3 percent had used crack cocaine and 11.6 percent had used amphetamines.

Researchers say the most disturbing finding was that only 10 percent of the addicts used methadone treatment in any given year of the study.

Hser explains methadone treatments in California are not subsidized. Nationwide, methadone only can be given at federally regulated clinics because it is considered a controlled substance.

The low rate of methadone treatment probably was linked to the group's high mortality rate, 48.9 percent, says addiction expert Dr. Patrick O'Connor, of Yale University's School of Medicine. Among those deaths, 21.6 percent were caused by a drug overdose.

"This was basically an epidemiological study of folks who were mostly not in treatment. There's a lot of morbidity in relation to heroin use. That doesn't surprise me. A lot of these folks missed out on treatment," O'Connor says.

"Anyone who says spending money on treating heroin addiction is a waste of time is out of their mind," O'Connor says. He cites studies that have shown that every $1 spent on treatment saves $7 in health-care and court costs down the road.

"It should be as least as accessible as other kinds of health care. I think it's a chronic disease, just like diabetes. It doesn't go away," he says.

The study also found that 46.7 percent of addicts had managed to stay away from heroin for at least five years, and they had much lower rates of criminal behavior, mental distress and higher rates of employment. While five years of abstinence reduced the likelihood of future relapse, a quarter of those who had been clean for 15 years eventually returned to heroin, the study found.

An estimated 800,000 to 1 million Americans use heroin daily.

Two new drugs are on the horizon that could provide more convenient alternatives to the methadone treatment. A recent study from Johns Hopkins University showed that levomethadyl acetate and buprenorphine worked as well as methadone to help heroin addicts. The drugs don't have to be taken daily, and eventually doctors may be able to prescribe buprenorphine, experts say.

Because levomethadyl acetate has caused some heart problems, Anglin says "buprenorphine looks like the shining star."

O'Connor says treatment of any kind is the only solution to heroin addiction.

"I think the response should be to give more treatment. We'd be doing ourselves a big favor to give treatment," he says.

What To Do

For more on heroin addiction, visit the National Institute on Drug Abuse and The National Center on Addiction and Substance Abuse.

Read these HealthDay stories on heroin addiction.

SOURCES: Interviews with Yih-Ing Hser, adjunct professor, substance abuse, UCLA's Neuropsychiatric Institute, Los Angeles; M. Douglas Anglin, director, UCLA Drug Abuse Research Center, Los Angeles; Patrick O'Connor, M.D., M.P.H., Yale University School of Medicine, New Haven, Conn., director, Primary Care Center, Yale-New Haven Hospital, New Haven, Conn.; May 14, 2001, Archives of General Psychiatry
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