Heroin Bests Methadone to Treat Some Addicts

Heroin Treatment

A Canadian study reports that heroin may be better than methadone in the treatment of long-term addicts. This “hair of the dog” type treatment appears to benefit heroin addicts who have not responded to methadone treatment.

According to the study, which appears in the August 20 issue of the New England Journal of Medicine, the majority of the estimated one million people addicted to opioids in North America are addicted to heroin. Up to one quarter of these addicts do not respond well to methadone, making it virtually impossible for them to shake their habit without another treatment approach. The use of medical heroin - injectable diacetylmorphine, which is the active ingredient in heroin - may be an answer.

In the Canadian study, the North American Opiate Medication Initiative researchers selected 251 heroin addicts who had at least a five-year history of opioid use and who were currently injecting opioids daily. The individuals randomly were assigned to receive oral methadone (111 participants), medical heroin injections (115), or injections of hydromorphone (25), a narcotic medication with effects similar to those of medical heroin.


Nearly 88 percent of the medical heroin group remained in the study, compared with 54 percent of those who received methadone. Illicit drug use or other illegal activities decline 67 percent in the medical heroin group and 48 percent in the methadone group. Ten nonfatal overdoses and six cases of seizures occurred in the medical heroin users, which indicates that this therapeutic approach should be used only when immediate medical interventions are available.

In a statement appearing in the online DbTechNo, Dr. Martin Schecter, the principle investigator of the study, said “We now have evidence to show that heroin-assisted therapy is safe and effective treatment for people with chronic heroin addiction who have not benefited from previous [methadone] treatments.” He noted that combining therapies may help the most seriously addicted individuals, keep them in treatment longer, and “help to improve their social and medical conditions.”

According to the latest figures available from the National Institute of Drug Abuse (the 2003 National Survey on Drug Use and Health), an estimated 3.7 million people had used heroin at some point in their lives, and about 314,000 Americans had used heroin in the past year. The majority of heroin users are male and age 26 years or older.

It is unlikely that medical heroin will be approved in the United States to treat addicts, where methadone is the treatment of choice. Hydromorphone, however, which has advantages similar to those of medical heroin, is approved for use in the United States. Because the current study did not include a sufficient number of people treated with hydromorphone, more research is needed in this area.

DbTechNo, 8/19/09
National Institute of Drug Abuse
US News & World Report