Diacetylmorphine injection, the active ingredient in heroin, which has been shown to be an effective alternative to oral methadone in opioid addiction overcome that did not respond to previous treatment.
Compared with methadone in a phase III trial, diacetylmorphine which leads to higher levels significantly reduce illegal activity and drug use after one year of treatment (67% versus 47.7%, P = 0.004), according to Martin Schechter, MD, PhD, from the University of British Columbia School of Population and Public Health in Vancouver, and colleagues.
Patients who received diacetylmorphine also had higher levels of retention in addiction treatment program in one year (87.8% versus 54.1%, P <0.001), the researchers report in the August 20 edition of the New England Journal of Medicine.
The values needed to treat of the two results is very low, according to Schechter - 5 for the reduction of illegal activities and drug use and 3 for retention.
According to Schechter methadone should remain the standard treatment for patients suffering from opioid dependence, and with diacetylmorphine reserved for 15% to 25% for those who do not respond.
"Methadone treatment remains a pretty good as the first treatment," he said, "but it's better to switch to heroin or using heroin in addition to increased effectiveness in this difficult population."
Joshua Lee, MD, from New York University, said of the validation of their research findings from Europe - that the treatment of heroin with a valid approach to treating addiction.
"In general," said Lee, who was not involved in the study, "it was a very positive development when a new treatment approaches that bring drug users into medicalized, and environmental therapy as further treatment may be established and associated problems such as the use of cocaine began to be overcome. "
Daniel Angres, MD, questioned the usefulness of both diacetylmorphine and methadone as a treatment option when an alternative with less potential for abuse - bupronorphine (marketed as Suboxone when combined with naloxone) and available.
Drugs are less likely to be abused, he said, because naloxone will prevent the effects of addiction bupronorphine if the medicine is injected.
To explore the treatment of diacetylmorphine in North American society, Schechter and his colleagues initiated the North American Opiate Medication Initiative (Naomi), is an open-label, in a phase III trial conducted in Montreal and Vancouver.
Experiments can not be done in the U.S. because of difficulties in obtaining financing and regulatory permission to inject heroin, says Schechter.
The participants of the long term as heroin users - meaning a period of 16.5 years who had at least two failed treatment efforts, one of which is owned methadone. About three-fourths had participated in illegal activities other than drug use in the months before the study began.
The investigators assigned to 111 participants on methadone and 115 on diacetylmorphine, which managed to three times a day with a maximum daily dose of 1,000 milligrams. And the treatment lasted one year.
At the end of treatment, a composite score for drug use and addiction disorders due to illegal activities in Europe with the Index increased significantly in both groups (P <0.01).
Patients who receive diacetylmorphine had been significant improvements in six of the seven sub-scales remained. Those who receive methadone improved in two things - the economic status and job satisfaction.
The advantage of diacetylmorphine groups larger than those in the methadone group for drug use, psychiatric status, job satisfaction, and social relationships (P ≤ 0.05 for all).
However, there is a more serious adverse events in groups of diacetylmorphine - 51 versus 18. None of the adverse events in the methadone group was due to the study treatment.
The most common serious adverse events with diacetylmorphine treatment of potentially life-threatening form of an overdose in 10 patients and seizures in six. But no patient died.
"We suggest that diacetylmorphine safety data should be delivered in settings where immediate medical intervention available," the researchers said.
Schechter added, however, that "we consider the results to show it is very safe."
Diacetylmorphine more expensive than methadone treatment, Schechter said. A year of treatment costs about $ 6,300 to $ 7,300 for the determination of heroin and approximately $ 2,700 to $ 3,600 for methadone.
But, he said, given the cost of untreated addiction to heroin is estimated around $ 50,000 per year - including the costs associated with medical care, prisons, and the legal process in which both, the treatment cost is very economical.
A formal analysis of cost effectiveness of sustainable, she said. In an accompanying editorial, Virginia Berridge, PhD, from the London School of Hygiene and Tropical Medicine, shows that European countries that have done similar experiments which have different responses in the outcome, and partly because of political and controversial nature of the treatment.
For example, she said, Switzerland and the Netherlands have begun to prescribe heroin as part of their medical system, while Germany and Spain have balked at the idea.
