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."
And for each patient, one drug may indeed be a better choice than others, says John Renner, MD, an associate professor of psychiatry at Boston University School of Medicine who was not involved in the study. This study was not designed to help determine which treatment is best for whom, he says, "but there is some indication that Orlaam and buprenorphine are better for very stable and motivated patients, while methadone seems to be the better choice for [long-term addicts who are] brand new to treatment."
There is widespread concern about sending "those who are very shaky and not in control to a private doctor's office," says Renner. For that population, methadone is probably best. But it may be equally unwise to send less-experienced users "to a methadone clinic, where they'll come into contact with hard-core [addicts] on a daily basis. Buprenorphine may be a better option for those people," he says,
According to Bigelow, Congress has just recently enacted legislation that is expected to allow buprenorphine, which is under review by the FDA, to be dispensed by doctors outside specialized narcotic treatment programs. This could mean that individuals leery of visiting a methadone clinic may be able to seek help directly from their family doctor. For now, however, it's unclear whether the new regulations will allow addicts to begin treatment with buprenorphine, or if a preliminary period of abstinence with the help of methadone will be required before they can "graduate" to the new medication.