Surprising Replacement for Methadone – More Heroin

A new study suggests that the most effective treatment for the severe forms of heroin addiction may not be giving methadone or suboxone. Instead, giving addicts therapeutic doses of heroin may keep them in treatment longer and provide more quality of life improvements.

This surprising finding is the result of a recent clinical trial in Canada that involved heroin addicts for whom conventional treatment with methadone had been unsuccessful. The test subjects were divided into two groups. Both groups were given intensive social and medical support, but one group was given heroin instead of methadone.

methadone tabletAmong the previously “untreatable” addicts who were treated with heroin, there was a decrease of 67% in crime and illegal drug use. For the addicts treated with methadone, the decrease was 48%. Even more important is the fact that only 22% of those treated with heroin dropped out of treatment compared to 46% of those treated with methadone.

For the group that was given heroin as part of their treatment for heroin addiction, injections were administered under medical supervision in a treatment center to decrease the risk of overdose and other life-threatening health problems. To avoid withdrawal, the addicts who were treated with heroin injected the drug two or three times per day. In contrast, methadone was administered every 24 to 36 hours on an outpatient basis. The drop in crime that was observed during the clinical trial was attributed to the heroin users staying in treatment longer due to the need for medical supervision.

The study seems to indicate that a treatment strategy that combines heroin and conventionally effective addiction treatment methods reduces the costs to society by reducing crime. Increases in employment and improved health were also higher among the heroin group, showing that addicts who undergo this treatment benefit from an improved quality of life as well as increased time spent in treatment.

Drug substitution is the most widely use form of treatment for opioid addiction, and methadone has long been the substitution drug of choice for heroin addiction.  Although methadone is unsuccessful for up to 25% of addicts, treating addiction with the drug of addiction remains controversial. This technique is used in Germany, Holland and the U.K., but there is opposition in the U.S. and Canada. Despite the promising results of the study, it is unlikely that heroin will replace methadone for treatment of heroin addiction any time soon.

The results of the Canadian clinical trial were published in the New England Journal of Medicine.