Prescription heroin helps addicts off street drugs

NEW YORK Fri May 28, 2010 10:38am EDT

Supplies including syringes, bandaids and antiseptic pads waits to be used by a drug addict inside a safe injection site on Vancouver, British Columbia's eastside August 23, 2006. REUTERS/Andy Clark

Supplies including syringes, bandaids and antiseptic pads waits to be used by a drug addict inside a safe injection site on Vancouver, British Columbia's eastside August 23, 2006.

Credit: Reuters/Andy Clark

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NEW YORK (Reuters Health) - Prescribing heroin to addicts who can't kick their habit helps them stay off street drugs, British researchers said Friday.

So far, doctors have had little hope of treating the 10 percent or more of heroin users who don't respond to methadone, the standard anti-addiction medication. Fueled by drug cravings, those users often spiral downward into crime and diseases spread by dirty needles and unhealthy living.

Short of actually getting addicts off the drug, "heroin clinics" can at least get them off the streets.

"What we are dealing with here is a very severe group of heroin addicts, where all of the treatments have been tried and have failed," said Dr. John Strang, an addiction expert at King's College London, who led the new study.

"They are like oil tankers heading for disaster," he added. "The question we were asking was, 'Can we change the trajectory of these tankers?' And the answer was, 'Yes we can.'"

To test how prescription heroin would work for this group, Strang and his colleagues invited 127 addicts into supervised injecting clinics. The researchers then randomly chose who would get heroin, injected methadone or typical swallowed methadone.

After six months, 101 addicts had stuck with their treatment. More than two-thirds of those on heroin had no sign of street heroin in their urine at least half the time they were tested; before the study, they had been using the street drug almost every day.

In comparison, less than a third of the addicts on either type of methadone had a similar number of "clean" tests.

At this point, said Strang, several users have continued in the program for more than two years. He did not have exact numbers, but told Reuters Health that some had been able to get jobs and reconnect with their families.

"These sorts of changes are typical of what we are seeing," he said. "People are not only physically getting better, but they're getting back into society."

The researchers had to treat about two addicts for each one who get off of street drugs at least half of the time.

An estimated 3.7 million people in the US have used heroin at some point in their lives, according to the National Institute on Drug Abuse. Of current users, studies suggest that some 200,000 spend time in jails each year.

The most common drug treatment for heroin users is methadone, a synthetic drug related to heroin. Although methadone decreases the cravings for its chemical cousin, it doesn't produce the same high, according to experts. This could help explain why a substantial proportion of addicts in treatment backslide.

Before the new study, a handful of other reports had indicated that prescription heroin could help these people. But the scientific community wasn't completely convinced, in part because earlier urine tests weren't very sophisticated.

"What this study did is that it used a very novel urine test that can differentiate between street heroin and prescription heroin," said Thomas Kerr, director of the Urban Health Research Initiative at the University of British Columbia in Vancouver, Canada. Street heroin contains papaverine, a remnant of the opium poppy that can be detected in the urine.

Now, he said, "the evidence is quite clear that there is a place for prescription heroin for the treatment of individuals who do not respond to methadone."

Only a few European countries prescribe heroin to addicts, and in the US this practice has been illegal since before World War I.

Many argue that giving addicts more of the substance they abuse makes little sense, and would be like treating an alcoholic with whiskey.

But Kerr said that analogy wasn't apt. "I would argue it's completely immoral and unethical to fail to treat those individuals and to allow them to suffer and allow the community around them to suffer," Kerr said.

Strang said he supported the UK Government's 2008 Drug Strategy, which proposes rolling out prescription heroin.

"Now that we know that it works, we have to debate whether or not we should use it," he said.

SOURCE: The Lancet, May 28, 2010. www.thelancet.com/

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Comments (6)
JackStraw wrote:
is this really newsworthy? i mean, you’re treating an addict with what he’s addicted to.

granted i don’t feel it should be treated any differently than methadone, not much is really changing in this ‘addiction treatment’ here except that they’re getting doped up with the real stuff not a synthetic substitute that’s just as bad.

still, does not present a valid treatment for addiction as the person is still dependent on heroin.

if anything, it suggests that supervised control of the substance should be favored as opposed to criminalization. same i’m sure goes for every drug

May 28, 2010 10:12am EDT  --  Report as abuse
JD-RN wrote:
What is funny in this article is that in certain instances, you actually do treat an alcoholic in the hospital with beer. It’s kept in the locked medicine fridge, and most hospitals stock Milwaukee Best.

This is a very good idea to try, so long as over the course of treatment a ramp-down plan is initiated. I would like to see the results of such an experiment.

May 28, 2010 1:21pm EDT  --  Report as abuse
KellyLynn426 wrote:
I don’t see this as being a valued treatment either. You’re not treating the addiction of the addict, seems as if it’s more swapping than anything else.

Has Heroin as a drug ever shown any promise to treat any diseases / disorders in society? I believe that is has not.

This drug from what I’ve seen in people has horrible psychological and physical addictions, that in communities if left properly untreated, increases disease, the possibility of overdose and certainly more crime – it destroys communties!

Marijuana, unlike Heroin, throughout history has not shown any physical addiction and has shown promise in some individuals with anxiety disorders and PTSD.

You continually hear the term “a drug is a drug”. As a society, we have learned over time that not all drugs are the same, based on the makeup and potential side effects.

What should matter is that if a drug can lesson symptoms of a diagnosed disease and/or disorder with minimal side effects, in addition to therapy then quite possibly it should be considered for legalization with supervised control.

May 28, 2010 1:32pm EDT  --  Report as abuse
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