NEW STUDY SUGGESTS ALTERNATIVE TO METHADONE IS MORE EFFECTIVE

The best way to treat some heroin addicts may be to give them pure,
pharmaceutical heroin, a new study argues.

The study, by Canadian researchers, found that injections of
prescription heroin were more effective in treating longtime addicts
than methadone, the most widely used treatment. Compared with addicts
in the study who got methadone, those who received heroin were more
likely to stay in treatment. Experts say lengthy treatment is often
needed to treat other diseases as well as provide counseling to
reverse criminal behavior and otherwise stabilize addicts' lives and
improve the chances that they will stop using heroin.

All of the participants had tried treatment with methadone, which
some addicts used for years, at least once and failed. Researchers
said the point of using heroin as an alternative wouldn't be to
immediately get addicts to stop taking the drug and didn't attempt to
measure how soon heroin users in each group might be able to kick the
habit. Rather, it would be to get them in to see doctors regularly
and reduce their use of street drugs and the commission of other
crimes. As with methadone, it would be up to the addict and his
doctor to determine when and if he was ready to be weaned off the
heroin by gradually taking smaller doses.

The new findings -- published online Wednesday by the New England
Journal of Medicine -- are in line with those from similar recent
studies conducted in Germany, Switzerland and other European
countries. But they are unlikely to have any immediate impact on
treatment in the U.S. since heroin is an illegal drug with no
federally approved medical uses.

Experts say any change in the drug's status, even for medical
purposes, is unlikely. "Politically it would be very difficult to get
any kind of support to do it," said Mark Parrino, president of the
American Association for the Treatment of Opioid Dependence, a
professional group. Opioids are a class of drugs that include heroin
and prescription narcotics such as OxyContin. Mr. Parrino wasn't
involved with the study.

Experts say just conducting a clinical trial involving heroin in this
country would involve getting special permission from the U.S. Drug
Enforcement Agency and the Food and Drug Administration. U.S.
researchers who had hoped to take part in the new Canadian study had
to drop out because they had difficulty getting such permission and
funding, said Martin Schechter, one of the study's co-authors.

In the U.S., heroin addicts are typically treated with methadone or
other drugs and also provided with other services if they want them.
Thomas Jefferson University Hospital in Philadelphia, for instance,
has a program called My Sister's Place that specializes in providing
long-term residential care for female addicts. The hospital also
offers family therapy, obstetrical care, methadone treatment and
nursery services for infants who exhibit signs of withdrawal.

The Canadian study, which lasted for 15 months, involved 251 longtime
addicts in Montreal and Vancouver. All were over 25 years old and had
been using heroin for at least five years. Participants had all been
treated at least twice for their addictions, including once with
methadone, a treatment that some addicts take for years to try to
control their heroin cravings.

A total of 111 participants received a daily dose of methadone,
typically a pill dissolved in liquid and taken orally. Of the 140
addicts in the prescription heroin group, 115 received daily
injections of that drug twice a day. An additional 25 received
injections of a prescription painkiller called hydromorphone, or
Dilaudid, although they didn't know it.

Dilaudid was used to test the reliability of the information
researchers were getting from the addicts about their use of illegal
drugs. If evidence of heroin appeared in the urine samples of those
participants, researchers would know it had been obtained on the
street, said Dr. Schechter, director of the School of Population and
Public Health at the University of British Columbia at Vancouver. No
evidence of heroin use was detected in those addicts during the
study, the study said.

In the study, the rates of illegal drug use and other illegal
activity fell by 67% in the heroin group and 48% in the methadone
group. Of the heroin-treated group, 88% stayed in treatment compared
with 54% of the other group.

Dr. Schechter said the researchers will apply to the Canadian
government to use prescription heroin as a treatment for addicts.