Heroin Prescription May Help Addicts: StudyOctober 26, 2001 By Amy Norton
NEW YORK (Reuters Health) - Providing heroin addicts with limited amounts of the drug may help some reach the goal of abstinence when other addiction treatments have failed, Swiss researchers report.
The controversial therapy has shown success in 21 outpatient treatment centers in Switzerland, according to a report in the October 27th issue of The Lancet. Investigators report that more than 70% of nearly 1,400 patients stuck with the treatment for more than a year, and the longer a patient stayed on, the more likely he was to start abstinence-based therapy.
Traditional treatments for heroin addiction include behavioral therapy and drugs such as methadone--an opiate that blocks the effects of heroin and reduces addicts' craving for the drug. In the US, methadone maintenance, as it is known, is the "gold standard" of treatment for heroin addiction.
But these tactics fail in some cases, with many heroin users choosing to drop out of treatment.
Digging for a way to help such addicts, some Swiss treatment centers began prescribing doses of heroin to patients in 1994. Besides the goal of weaning addicts from heroin, the rationale behind the therapy is that giving users a controlled source of the drug will reduce the risk of overdose, medical complications and criminal behavior associated with street drugs.
"You basically buy time and the opportunity to reintegrate them into society.... You prescribe heroin when there is no other alternative," Jurgen Rehm, the study's lead author, told Reuters Health.
To see whether heroin-assisted treatment can work, Rehm and his colleagues at the Addiction Research Institute in Zurich followed the Swiss program for 6 years. All patients in 21 clinics received daily doses of heroin and psychological counseling, along with methadone when needed. All had previously failed other addiction treatment.
The investigators found that a majority stayed with the program for more than one year, and overall, 60% went on to start another treatment--usually methadone maintenance or abstinence-based therapy. In addition, the longer patients stayed on heroin-assisted therapy, the more likely they were to move on to abstinence-based treatment.
In a subset of patients who were followed for 18 months, the researchers also found improvements in mental health, fewer skin infections and less criminal behavior.
These are important factors to look at in evaluating any heroin-addiction treatment program, Dr. Frank Vocci, of the National Institute on Drug Abuse in Bethesda, Maryland, said in an interview.
Questions about the heroin-assisted tactic remain, including which addicts will best respond to it, Rehm's team agrees. In addition, they report, the therapy works as part of a "well-developed and versatile" system in Switzerland that includes abstinence-oriented treatment and methadone maintenance.
The concept of giving an addict controlled doses of his drug of choice is not new, Dr. Ernest Drucker points out in an accompanying editorial.
Before the 1920s, early morphine-maintenance programs operated in the US before they were shut down by "prohibitionary fervor," notes Drucker, of Albert Einstein College of Medicine in New York.
He argues that the current findings "should dispel fears that the availability of heroin undermines interest in drug-free treatment."
But whether heroin-assisted treatment will become more widespread is unclear, as Drucker notes that the Swiss trials have met with criticism in the US--where, he writes, the care of drug addicts has often been left to the "tender mercies of law enforcement."
Drucker concludes, "The chorus of poorly informed criticism and misinformation that has greeted the Swiss heroin trials in the USA reveals the depth of this old conflict and underscores the importance of this report."
SOURCE: The Lancet 2001;358:1385, 1417-1420.