STUDY SHOWS TWO DRUGS AS EFFECTIVE AS METHADONE

The first head-to-head comparison of treatments for heroin addiction found
that two newer, easier-to-take medicines work just as well as methadone,
the standard drug since the 1960s.

Unlike methadone, which has to be taken daily, the two other drugs are
longer-acting and can be taken only three times a week.

Previous studies have shown all three medications -- methadone, Orlaam and
buprenorphine -- to be effective in treating heroin addiction. This study
looked at them together for the first time. The findings were published in
today's New England Journal of Medicine.

The two newer drugs could improve treatment of heroin addiction by giving
doctors more options, said researcher Rolley E. Johnson of Johns Hopkins
University School of Medicine, who led the study.

"There are some patients who perhaps have tried methadone and didn't think
it was the thing that could help them. They may benefit from (Orlaam) or
they may benefit from buprenorphine," said Johnson, who has worked as a
consultant for makers of all three medications.

Methadone, a synthetic narcotic, has been used for more than 30 years to
treat heroin addiction. It suppresses withdrawal symptoms and curbs the
craving for heroin.

Orlaam, another synthetic narcotic known generically as levomethadyl
acetate, was approved in 1993 but has not been widely used. Buprenorphine,
also a synthetic narcotic, is awaiting approval from the Food and Drug
Administration for use as an anti-addiction drug. It causes weaker narcotic
effects.

Methadone and Orlaam are liquids, while buprenorphine will be marketed as a
tablet. But all three drugs were given in liquid form during the study so
that participants would not know what they were getting.

There are an estimated 980,000 chronic heroin users and 20 percent to 30
percent of them are in treatment, according to the government's Office of
National Drug Control Policy.

The study's findings point to more options for doctors and ways of treating
more patients, said Alan I. Leshner, director of the National Institute on
Drug Abuse, which paid for the research.

"We need, like any illness, to have an array of treatments in the clinical
toolbox," Leshner said.

To test the three medications, researchers at Johns Hopkins recruited 220
heroin addicts and treated them for 17 weeks in 1996-97. The patients were
given one of the three medications -- Orlaam or buprenorphine three times a
week, or a high dose of methadone daily. A fourth, control group was
treated with a low dose of methadone each day.

Researchers tracked the patients' continued use of heroin, and the
participants graded the severity of their drug problem.

High-dose methadone and the two newer medications were all effective in
treating heroin addiction, and all worked significantly better than
low-dose methadone. Patients in all four groups reported a 90 percent drop
in heroin use when they began treatment.

High-dose methadone was the best at keeping patients in treatment: an
average of 105 days out of 119. Orlaam was the best at keeping patients
away from heroin; 36 percent of that group tested negative for heroin use
for a month or longer.

No serious side effects were reported for any of the medicines.
Participants complained of such things as constipation, nausea and dry mouth.

Johns Hopkins said it pays $3.15 a week for methadone and $13.60 a week for
Orlaam. Buprenorphine is expected to cost more than Orlaam.

Johnson said recent federal legislation will allow doctors in office-based
practices to prescribe buprenorphine once it is approved by the FDA. The
more tightly controlled methadone and Orlaam are now dispensed through
heavily regulated clinics only.

Methadone treatment is not even available in six states -- Idaho,
Mississippi, Montana, North Dakota, South Dakota and West Virginia --
according to the Lindesmith Center-Drug Policy Foundation, a New York-based
institute that advocates drug policy reform.