Thursday, August 27, 2009

Medically Prescribed Heroin

There was a very interesting study that just came out in the New England Journal of Medicine. It was a Canadian study which compared medically prescribed heroin and methadone to see which is more effective for long term, chronic, treatment refractory opioid addiction. Chronic intravenous heroin addiction is extremely difficult to treat with most patients experiencing multiple relapses and often simply dropping out of treatment. There are multiple complications including very high rates of Hepatitis C and HIV infections as well as strong association with various criminal behaviors. As most heroin addicts are unable to successfuly maintain abstinence the concept of harm reduction is often used as a goal rather than sustained abstinence. The idea is to reduce the risks of chronic communicable infections and criminal behavior by various means such as providing needle exchange programs, safe injection sites, and opioid substitution with either methadone or buprenorphine. Rates of illicit drug use and criminal behavior drop about 50% with use of methadone but there remains a large number of addicts who continue to use even while on methadone or drop out of treatment altogether.

Medically prescribed heroin has been used in Europe before but never in North America. The plan was to do the study both in Canada as well as the United States but the researchers could not get govermental approval here. At 12 months 87.8% of individuals taking the heroin remained in treatment compared to 54.1% of those on methadone and reduction in rates of illicit drug use and criminality was 67% compared with 47.7%  with methadone. The average daily dose was 392.3 milligrams per day and generally was given twice per day. It is interesting that there were 51 serious adverse events out of a total of 89,924 injections including 10 overdoses and 6 seizures. The overdoses were treated and the was no long term effect.

What was not commented on by the researchers were what the base rate of hepatitis C and HIV were and whether the one year treatment resulted in any change in newly diagnosed cases. I think this is important to know to help determine whether or not it is cost effective to provide heroin to addicts. There was also no comment on what rates of illegal diversion are seen in Europe. I also would like to see some comparison in disease rates with needle exchange programs.

I do not think that we will be seeing medically prescribed heroin in the United States in any near future but am interested in the experiences in Canada if they at some time adopt this approach.

Thought for the day

Harm reduction is controversial in the United States but I believe has real merit as an alternative strategy to abstinence and I would like to see more needle exchange programs here.

1 comment:

  1. this will work, i been waiting to get on methadone for 8 months now. and even with that u still may use a contract hiv or hep c. just look at the sucess in other countries. i really dont think the us will do it either, there are too many hipocrits in office and the bueraucrats will stick up their nose and talk about how wrong it is even though it will benifit and save our lives of us people who will continue commiting crimes to get our drugs on the streets no matter the consequences because of our addictions. adopting this policy will save millions of lives in the u.s and do alot of good with eliminating money going to terrorisim and crime in the u.s done by dealers and addicts uying illegal drugs that fund more crime. this way crime will lower, money will go to our government and the lives of addicts will get much better. without risking jail by buying drugs, we can go to treatment have normal jobs and not think of ourselves as criminals

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