Study: Alternatives to Methadone Work
Nov. 1, 2000 -- — The first head-to-head comparison of treatments for heroinaddiction found that two newer, easier-to-take medicines work justas well as methadone, the standard drug since the 1960s.
Unlike methadone, which has to be taken daily, the two otherdrugs 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 heroinaddiction. This study looked at them together for the first time.The findings were published in Thursday’s New England Journal ofMedicine.
Two Rather Than One
The two newer drugs could improve treatment of heroin addictionby giving doctors more options, said researcher Rolley E. Johnsonof Johns Hopkins University School of Medicine, who led the study.
“There are some patients who perhaps have tried methadone anddidn’t think it was the thing that could help them. They maybenefit from [Orlaam] or they may benefit from buprenorphine. Maybewe can get those people back into treatment,” said Johnson, whohas worked as a consultant for makers of all three medications.
Methadone, a synthetic narcotic, has been used for more than 30years to treat heroin addiction. It suppresses withdrawal symptomsand curbs the craving for heroin.
Orlaam, another synthetic narcotic known generically aslevomethadyl acetate, was approved in 1993 but has not been widelyused. Buprenorphine, also a synthetic narcotic, is awaitingapproval from the Food and Drug Administration for use as ananti-addiction drug. It causes weaker narcotic effects.
Methadone and Orlaam are liquids, while buprenorphine will bemarketed as a tablet. But all three drugs were given in liquid formduring the study so that participants would not know what they weregetting.
Different Options for Treatment
There are about 1 million chronic heroin users by governmentestimates, said Alan I. Leshner, director of the National Instituteon Drug Abuse, which paid for the research. He said the findingspoint to more options for doctors and ways of treating morepatients.
“We need, like any illness, to have an array of treatments inthe clinical toolbox,” Leshner said.
To test the three medications, researchers at Johns Hopkinsrecruited 220 heroin addicts and treated them for 17 weeks in1996-97. The patients were given one of the three medications — Orlaam or buprenorphine three times a week, or a high dose ofmethadone daily. A fourth, control group was treated with a lowdose of methadone each day.
Researchers tracked the patients’ continued use of heroin, andthe participants graded the severity of their drug problem.
Variety of Treatments Helped
High-dose methadone and the two newer medications were alleffective in treating heroin addiction, and all workedsignificantly better than low-dose methadone. Patients in all fourgroups reported a 90 percent drop in heroin use when they begantreatment.
High-dose methadone was the best at keeping patients intreatment: an average of 105 days out of 119. Orlaam was the bestat keeping patients away from heroin; 36 percent of that grouptested 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 anddry mouth.
Johns Hopkins said it pays $3.15 a week for methadone and $13.60a week for Orlaam. Buprenorphine is expected to cost more thanOrlaam.
Johnson said recent federal legislation will allow doctors inoffice-based practices to prescribe buprenorphine once it isapproved by the FDA. The more tightly controlled methadone andOrlaam 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 NewYork-based institute that advocates drug policy reform.