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Winter 2009/10 | Vol 13 No 2

Research update

Mark de la Hey

Heroin maintenance therapy more effective than methadone

Prescription heroin appears to be more effective than methadone in maintenance therapy for people with heroin addiction, according to research from the University of British Columbia in Vancouver. The study involved 251 long-term heroin users in Vancouver and Montreal, 111 of whom were randomly assigned to receive oral methadone, while 115 received injectable diacetylmorphine (the active ingredient in heroin). In addition, 25 participants were assigned injectable hydromorphone for the purpose of validating self-reported use of street heroin. The injectable medications were self-administered under supervision at treatment clinics. After one year, 88 per cent of participants who received heroin remained in treatment, compared with 54 per cent of those who received methadone. Rates of illicit drug use and other illegal activity were reduced by 67 per cent in the heroin maintenance group, while the methadone group saw a 48 per cent reduction. The heroin maintenance group also showed greater improvement in physical and mental health, economic well-being, employment and family and social relationships. However, those given heroin experienced more serious adverse events (51 in total), including 11 overdoses and seven seizures, which resulted from the study drug. Methadone treatment resulted in only 18 adverse events, none resulting from the study drug. The authors recommend that heroin maintenance therapy be provided in settings where medical personnel are available for prompt intervention. Although the authors conclude that methadone should remain the treatment of choice for most people with heroin dependence, they assert that prescription heroin is a “safe and effective adjunct treatment” for people who do not benefit from methadone treatment.

New England Journal of Medicine, August 20, 2009, 361: 777–786. Eugenia Oviedo-Joekes et al., School of Population and Public Health, University of British Columbia, Vancouver, British Columbia.