STUDY BACKS HEROIN TO TREAT ADDICTION

The safest and most effective treatment for hard-core heroin addicts
who fail to control their habit using methadone or other treatments
may be their drug of choice, in prescription form, researchers are
reporting after the first rigorous test of the approach performed in
North America.

For years, European countries like Switzerland and the Netherlands
have allowed doctors to provide some addicts with prescription heroin
as an alternative to buying drugs on the street. The treatment is safe
and keeps addicts out of trouble, studies have found, but it is
controversial -- not only because the drug is illegal but also because
policy makers worry that treating with heroin may exacerbate the habit.

The study, appearing in the current issue of the New England Journal
of Medicine, may put some of those concerns to rest.

"It showed that heroin works better than methadone in this population
of users, and patients will be more willing to take it," said Dr.
Joshua Boverman, a psychiatrist at Oregon Health and Science
University in Portland.

Perhaps the biggest weakness of methadone treatment, Dr. Boverman
said, is that "many patients don't want to take it; they just don't
like it."

In the study, researchers in Canada enrolled 226 addicts with
longstanding habits who had failed to improve using other methods,
including methadone maintenance therapy. Doctors consider methadone, a
chemical cousin to heroin that prevents withdrawal but does not induce
the same high, to be the best treatment for narcotic addiction. A
newer drug, buprenorphine, is also effective.

The Canadian researchers randomly assigned about half of the addicts
to receive methadone and the other half to receive daily injections of
diacetylmorphine, the active ingredient in heroin. After a year, 88
percent of those receiving the heroin compound were still in the
study, and two-thirds of them had significantly curtailed their
illicit activities, including the use of street drugs. In the
methadone group, 54 percent were still in the study and 48 percent had
curbed illicit activities.

"The main finding is that, for this group that is generally written
off, both methadone and prescription heroin can provide real
benefits," said the senior author, Martin T. Schechter, a professor in
the School of Population and Public Health at the University of
British Columbia.

Those taking the heroin injections did suffer more side effects; there
were 10 overdoses and six seizures. But Dr. Schechter said there was
no evidence of abuse. The average dosage the subjects took was 450
milligrams, well below the 1,000-milligram maximum level.

About 663,000 Americans are regular users of heroin, according to
government estimates. The researchers said 15 percent to 25 percent of
them were heavy users and could benefit from prescription heroin. That
is, if they ever were to get the chance. Heroin is an illegal,
Schedule 1 substance, meaning it has a high potential for abuse and
serves no legitimate medical purpose. That designation is unlikely to
change soon, researchers suspect.

In an editorial with the article, Virginia Berridge of the London
School of Hygiene and Tropical Medicine concluded, "The rise and fall
of methods of treatment in this controversial area owe their rationale
to evidence, but they also often owe more to the politics of the
situation."