Heroin More Effective Than Methadone?

Drug War Chronicle

from Drug War Chronicle, Issue #598, 8/21/09

In a report that was actually completed last October but not published until this week in the New England Journal of Medicine, researchers from the North American Opiate Medication Initiative (NAOMI) found that giving heroin under supervision to some hard-core drug addicts was more effective than giving them methadone. The study's publication in the prestigious peer-reviewed journal is already leading to calls for experiments with heroin maintenance in the US. To qualify for the study, participants had to have been addicted to heroin, Dilaudid, or another opiate for at least five years, have been injecting for at least the past year, have tried addiction treatment, including methadone maintenance, at least twice, and be at least 25 years of age. While researchers were loathe to generalize their findings, they described heroin maintenance as "a safe and effective treatment" for chronic addicts who have not taken to other forms of treatment.

In the NAOMI project, researchers monitored 251 heroin addicts in Vancouver and Montreal and provided them with maintenance drugs for a year under the supervision of nurses, doctors, social workers, and psychiatrists. One hundred fifteen received pharmaceutical heroin (diacetylmorphine), 111 received methadone, and 25 received Dilaudid (hydromorphone).

Among participants who received heroin by injection, 88% completed the program compared to 54% of those receiving oral methadone. Similarly, illicit drug use rates dropped by 67% among those receiving heroin, compared to 48% among those receiving methadone.

"Our data show remarkable retention rates and significant improvements in illicit heroin use, illegal activity and health for participants receiving injection assisted therapy, as well as those assigned to optimized methadone maintenance," said Dr. Martin Schechter, principal investigator for the Center for Health Evaluation and Outcome Sciences at the University of British Columbia School of Population and Public Health and NAOMI's lead researcher. "Prior to NAOMI, all of the study participants had not benefited from repeated standard addiction treatments. Society had basically written them off as impossible to treat," he said.

"We now have evidence to show that heroin-assisted therapy is a safe and effective treatment for people with chronic heroin addiction who have not benefited from previous treatments. A combination of optimal therapies -- as delivered in the NAOMI clinics -- can attract those most severely addicted to heroin, keep them in treatment and more importantly, help to improve their social and medical conditions," explained Schechter.

The NAOMI research results mirror similar findings from a number of European countries, a fact noted in a Journal editorial by Virginia Berridge. "The results of this trial may be added to those from Germany, the Netherlands, Spain and Switzerland," Berridge wrote. "Switzerland has 10 years of experience in the prescription of heroin, and in a November 2008 referendum, 68% of voters were in favor of its continued prescription."