Study: Alternatives to Methadone Work

— The first head-to-head comparison of treatments for heroin addiction found that two newer, easier-to-take medicines work just as well as methadone, the standard drug since the 1960s.

Unlike methadone, which has to be taken daily, the two other drugs are longer-acting and can be taken only three times a week.

Previous studies have shown all three medications — methadone, Orlaam and buprenorphine — to be effective in treating heroin addiction. This study looked at them together for the first time. The findings were published in Thursday’s New England Journal of Medicine.

Two Rather Than One

The two newer drugs could improve treatment of heroin addiction by giving doctors more options, said researcher Rolley E. Johnson of Johns Hopkins University School of Medicine, who led the study.

“There are some patients who perhaps have tried methadone and didn’t think it was the thing that could help them. They may benefit from [Orlaam] or they may benefit from buprenorphine. Maybe we can get those people back into treatment,” said Johnson, who has worked as a consultant for makers of all three medications.

Methadone, a synthetic narcotic, has been used for more than 30 years to treat heroin addiction. It suppresses withdrawal symptoms and curbs the craving for heroin.

Orlaam, another synthetic narcotic known generically as levomethadyl acetate, was approved in 1993 but has not been widely used. Buprenorphine, also a synthetic narcotic, is awaiting approval from the Food and Drug Administration for use as an anti-addiction drug. It causes weaker narcotic effects.

Methadone and Orlaam are liquids, while buprenorphine will be marketed as a tablet. But all three drugs were given in liquid form during the study so that participants would not know what they were getting.

Different Options for Treatment

There are about 1 million chronic heroin users by government estimates, said Alan I. Leshner, director of the National Institute on Drug Abuse, which paid for the research. He said the findings point to more options for doctors and ways of treating more patients.

“We need, like any illness, to have an array of treatments in the clinical toolbox,” Leshner said.

To test the three medications, researchers at Johns Hopkins recruited 220 heroin addicts and treated them for 17 weeks in 1996-97. The patients were given one of the three medications — Orlaam or buprenorphine three times a week, or a high dose of methadone daily. A fourth, control group was treated with a low dose of methadone each day.

Researchers tracked the patients’ continued use of heroin, and the participants graded the severity of their drug problem.

Variety of Treatments Helped

High-dose methadone and the two newer medications were all effective in treating heroin addiction, and all worked significantly better than low-dose methadone. Patients in all four groups reported a 90 percent drop in heroin use when they began treatment.

High-dose methadone was the best at keeping patients in treatment: an average of 105 days out of 119. Orlaam was the best at keeping patients away from heroin; 36 percent of that group tested negative for heroin use for a month or longer.

No serious side effects were reported for any of the medicines. Participants complained of such things as constipation, nausea and dry mouth.

Johns Hopkins said it pays $3.15 a week for methadone and $13.60 a week for Orlaam. Buprenorphine is expected to cost more than Orlaam.

Johnson said recent federal legislation will allow doctors in office-based practices to prescribe buprenorphine once it is approved by the FDA. The more tightly controlled methadone and Orlaam are now dispensed through heavily regulated clinics only.

Methadone treatment is not even available in six states — Idaho, Mississippi, Montana, North Dakota, South Dakota and West Virginia — according to the Lindesmith Center-Drug Policy Foundation, a New York-based institute that advocates drug policy reform.

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