HEROIN ADDICTS PAID TO INJECT FREE DRUGS

Research aimed at finding cure

NEW YORK

- -- Taking a bold approach to addiction, researchers at Columbia University
are offering free heroin to addicts and paying them to use it.

The federally authorized program is aimed at finding a cure for their drug
habits.

Two trials involving heroin injections are among six related drug-addiction
studies being conducted at Columbia's College of Physicians and Surgeons.
All the studies focus on the role existing medications can play in defeating
heroin or cocaine addictions.

Since September, 14 addicts have received regular doses of pure heroin after
being given naltrexone (pronounced nal-TREX-own), buprenorphine
(boo-pruh-NOR-fin) or methadone. Those medications are effective in
neutralizing heroin's high.

The researchers want to learn whether stronger doses of these medications
are needed and can be prescribed without risk. Heroin being sold on the
streets is increasingly pure.

"A dose that was probably good enough 15 years ago may not be good enough
for heroin now," said Dr. Herbert Kleber, a professor of psychiatry at
Columbia. He directs the medical college's division on substance abuse and
is medical director of the National Center on Addiction and Substance Abuse
at Columbia.

Heroin and cocaine have been tested on mice and other laboratory animals.
But Columbia's study is the only one in the country testing addicts with
heroin. Researchers at Harvard have done so and researchers at Johns Hopkins
plan to.

"If you have a promising drug in animal trials," Kleber said, "you need to
do it in human trials to see if it adequately works, because we're different
from animals in physiology, metabolism and the ability to report on
subjective effects" of drugs such as heroin.

The medications being tested affect the brain different ways.

Naltrexone is an antagonist; it blocks the effect of heroin on the brain's
receptors. Methadone is an agonist, which stifles the craving for heroin by
binding to the brain receptor. The third, buprenorphine, acts as an agonist
at lower doses and as an antagonist at higher doses.

Unlike methadone, naltrexone could be available with just a doctor's
prescription. A dose lasts only a day or so and leaves some users feeling
anxious and unhappy; many tend to quit. Fewer than 2,000 heroin addicts
nationwide take naltrexone, compared with 115,000 methadone users.

In one study, the researchers are experimenting with a slow-release form of
naltrexone that lasts 30 days.

The second study involves buprenorphine, which is undergoing approval by the
Food and Drug Administration, and methadone. The study gives participants
who have received a dose of either drug the chance to perform laboratory
tasks for heroin or for money.

If the drug works properly, the addict will logically choose the cash. To
earn a full dose of heroin or $20, the participant must work hard, by
pushing a button as many as 11,500 times.

The National Institute on Drug Abuse is financing all six studies with
$708,000 in grants this year.

Dr. Marian Fischman, a psychologist at Columbia who studies medications for
drug abusers, said the volunteers, who agree to stay in the hospital for six
or seven weeks, had rejected offers to treat their heroin habit.

The volunteers first go through several days of detoxification, in which
their heroin is stopped and they are put on sufficient buprenorphine to
suppress the pangs of withdrawal.

Then they are given naloxone, a medication used to treat heroin overdoses,
to make them ready for naltrexone. Once this is administered, they go back
to heroin to see whether it is neutralized by the naltrexone and for how
long.

The addict is wired to a battery of machines measuring vital functions such
as heart rate and blood pressure.

During the sessions, which last about two hours, the addicts answer a
succession of questions from the computer. Are they yawning or sweating? Do
they feel depressed, sedated or energetic? How much would they pay for the
heroin they feel, on a scale from nothing to $20? On the street, a bag of
heroin supplying a single high costs $10.

The addict is also asked to perform tasks, like duplicating patterns on a
computer screen. "People who are intoxicated have an impairment of higher
functions," said Dr. Adam Bisaga, a psychiatrist who helps supervise the
tests.

During their hospital stays, the addicts attend lectures about heroin's
effects on their bodies and learn ways to shake the habit.

The addicts agree to participate in the studies for $25 a day. If they
complete the study, the amount doubles, for a maximum of about $2,700. The
payments must be picked up in weekly intervals of $300 after the study is
over.

When the participants collect their checks, study workers try to counsel
them to seek treatment.

A third study financed under the federal grant focuses on heroin users who
do want treatment. They are given naltrexone, but no heroin, as outpatients,
with a spouse or friend as a monitor.

About 810,000 Americans regularly use heroin, according to the White House's
Office of National Drug Control Policy, and 3.6 million are regular cocaine
users, but a proven cure for their addiction has yet to be found.

And even when an addict withdraws from heroin, a cocaine habit often
remains.

Dr. Edward Nunes, the investigator for the cocaine studies, estimated that
at least 25 percent of people who take methadone to block their addiction to
heroin continue abusing cocaine.

To that end, the three other Columbia studies are looking at cocaine and how
its use is affected by various medications. No cocaine is dispensed in these
studies. The volunteers have accepted the offer for treatment.

Earlier studies have suggested that some medications may be useful in
blocking or diluting a cocaine high.