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New Options for Addicts Wanting to Kick the Habit

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Nov. 1, 2000 -- Methadone may be the gold standard, but it is no longer the sole effective option for treating heroin addiction, according to a new study. Researchers from Johns Hopkins University tell WebMD that the drugs Orlaam and buprenorphine are equally effective at reducing heroin use, and buprenorphine may soon be available from family doctors.

"All three of the medications we tested ... were remarkably effective," says researcher George E. Bigelow, PhD, a professor in the department of psychiatry and behavioral sciences. "There are some subtle differences between them, so if a patient is not doing as well as hoped on one, physicians will have the option of choosing between medications."

The researchers randomly assigned 220 heroin-addicted people, aged 21 to 55, to individually tailored dosages of Orlaam three times a week, buprenorphine three times a week, high-dose methadone once daily, or a standard low-dose daily methadone. Subjects underwent regular urine drug tests and completed surveys on the severity of their dependency. The findings appear in the Nov. 2 issue of The New England Journal of Medicine.

Just over half of the participants managed to complete the treatment, which lasted about four months. Addicts taking Orlaam, buprenorphine, and the higher methadone dosage stuck it out longer than those on the low-dose methadone, which acted as a comparison group. In general, those on high-dose methadone were most likely to remain in the study.

Compared with the comparison group, those on Orlaam, buprenorphine and high-dose methadone were more likely to have 12 or more consecutive clean drug urine tests. On the last survey they completed, all subjects who were taking an individually tailored dosage -- regardless of the drug -- reported their drug problem as being less severe than did the others.

For keeping participants in the study, methadone was the best, Bigelow tells WebMD, "and [Orlaam] was most successful in terms of patients maintaining prolonged abstinence. But individually tailored doses of all the medications were significantly better than low-dose methadone."

According to Bigelow, "the main message is that we've got an assortment of remarkably effective treatment medications for [heroin] addiction. Whereas largely in the past, there has only been one medication available -- methadone."

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