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Treating opioid addiction with heroin rather than methadone

A recent study published in the Canadian Medical Association Journal suggests that treating opioid addiction with heroin is not only more effective at combating dependence, but also more cost efficient than using methadone. [h/t CBC News]

The study draws on data from The North American Opiate Medication Initiative, “a randomized controlled trial that compared supervised, medically prescribed injectable diacetylmorphine [heroin] and optimized methadone maintenance treatment in people with long-standing opioid dependence and multiple failed treatment attempts with methadone or other forms of treatment.” The trials were conducted in Vancouver, British Columbia and Montréal, Quebec.

Researchers gave addicts the “option of trying methadone or diacetylmorphine [heroin] under medically supervised conditions, and we found people who were getting diacetylmorphine were retained in treatment much, much longer, so they had a much better outcome . . ..” In fact, the use of heroin was found to be a “dominant strategy” over methadone treatment, as those treated with heroin had longer life expectancies, remained in treatment longer, and suffered fewer years in relapse:

Over a lifetime horizon, people in the methadone cohort lived 14.54 years on average following entry into the model, spending 8.79 years (60% of their remaining life) in treatment and 5.52 years in relapse. […] People in the diacetylmorphine cohort lived 15.45 years on average, spending 10.41 years (67% of their remaining life) in treatment . . . and 4.05 years in relapse. […] Based on these findings in the baseline model, over a lifetime horizon the provision of diacetylmorphine in the hypothetical cohort provided greater incremental health benefits . . . compared with methadone maintenance treatment.

Cost savings are ascribed to the addicts treated with heroin remaining in treatment for longer periods of time while suffering fewer instances of relapse. Longer stays in treatment led to lower health care costs overall, “when the cost of the drugs, counseling and social supports were added up.”

The study further indicates the cost efficiency of using heroin is attributed to decreases in costs connected to crime and criminal activity. This is due to the fact that “opioid users commit less crime and have lower rates of health care use and death while in treatment, the benefits in cost . . . stemmed chiefly from its capacity to retain patients in treatment for longer periods than with methadone maintenance treatment.”

These findings are in accord with previous research published in the New England Journal of Medicine back in 2009, as well as two Dutch studies of methadone maintenance programs.

Yet, methadone remains the most common method used for treating opioid addiction despite the fact that, “most people who receive opioid substitution treatment are unable to abstain from illicit drug use for sustained periods, either switching from treatment to regular opioid use or continuing to use opioids while in treatment.”

Thanks to the War on Drugs, the United States prohibits doctors from prescribing heroin to opioid addicts. Under 21 U.S.C. § 812 of the Controlled Substances Act, heroin is listed as a Schedule I narcotic. Drugs classified under Schedule I are presumed to have no accepted medical use in treatment and a lack of accepted safety use under medical supervision.

However, this study, and the findings of similar research, seems to rebut that presumption. Simply re-scheduling heroin to Schedule II would allow the drug to be prescribed by doctors for medical purposes. That small measure will allow the U.S. to reap some of the benefits associated with using heroin instead of methadone for managing opioid addiction – while also allowing for greater study and research on the effects of such a course of treatment that U.S. law does not currently allow.

Cross posted at

A complete archive of Spatial Orientation drug policy blogposts are also available here.

Image via Wikipedia

  1. April 5, 2012 at 10:48 pm

    The producers of this short film are both recovering addicts who have both spent time living and indulging with drug addiction in Vancouverâs Downtown Eastside. Today they are both clean and sober with multiple years of recovery The reasons for the making of this film are many, one being educational the other sharing with those who have suffered, this is a view of what life can be like in addiction and how extreme addiction can be The video was shot entirely in the downtown eastside it is a compilation of two years work with a variety of themes.We hope that by watching this work people will get a better understanding from a real perspective of what can happen to anyone who may slip through the cracks of society and end up with a drug problem. Some of the material may seem to be offensive or extreme but our experience has taught us that you cannot sugar coat a disease. If our work will deter any single individual from this horrendous lifestyle we feel our goal has been accomplished At this time I’d like o point out that we have had no formal training in video photo editing producing or directing this project ran both on emotion and desire to carry a message from our perspective.


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