Medical Heroin Found Effective for Treatment-Refractory Opioid Addiction

Aug. 23, 2009— -- Injectable diacetylmorphine, the active ingredient in heroin, was shown to be an effective alternative to oral methadone in treating opioid addiction that had not responded to previous treatment.

Compared with methadone, a commonly used drug used in heroin addiction treatment, diacetylmorphine led to 67 percent less illegal activity and illicit drug use after one year of treatment, compared to a 47.7 percent reduction with methadone, according to Dr. Martin Schechter of the University of British Columbia School of Population and Public Health in Vancouver and colleagues.

In addition, patients receiving diacetylmorphine had higher rates of retention in addiction treatment programs at one year -- 87.8 percent versus 54.1 percent -- the researchers reported in the Aug. 20 issue of the New England Journal of Medicine.

Schechter said methadone should remain the standard treatment for most patients with opioid dependence, with diacetylmorphine reserved for the 15 percent to 25 percent who don't respond.

"Methadone remains a pretty good first-line treatment," he said, "but either the switch to heroin or using heroin as an adjunct obviously has increased effectiveness for this difficult population."

Dr. Joshua Lee of New York University said the findings validate those from European studies -- that medical heroin is a valid approach to treating addiction.

"Generally," said Lee, who was not involved in the study, "it is a very positive development when a new treatment approach ... brings drug users into a medicalized, therapeutic environment where further treatment can be established and related problems like cocaine use can begin to be addressed."

Dr. Daniel Angres, psychiatrist and author of Healing the Healer: The Addicted Physician, questioned the usefulness of both diacetylmorphine and methadone as treatment options when an alternative with less abuse potential, bupronorphine, is available.

The drug is less likely to be abused, he said, because the naloxone would block the opiate effect of bupronorphine if the drug were injected.