A user prepares heroin he bought on the street to be injected at the Insite supervised injection facility in Vancouver, May 11, 2011.JOHN LEHMANN
Methadone might not be the most effective way to treat opioid addiction, suggests a new study.
People who take diacetylmorphine – the active ingredient in heroin – for addiction appear more likely to adhere to treatment, and they end up costing society less than those taking methadone, according to a study published Monday in the Canadian Medical Association Journal.
Although methadone isthe most common treatment for opioid addiction, many people who take it eventually return to drug abuse (as do some of those who take diacetylmorphine). At the same time, diacetylmorphine is much costlier than methadone.
The issue of which treatment is more effective is significant because of the high rates of opioid addiction across Canada. Opioids are powerful narcotic painkillers. Although they have been around for decades, addiction rates skyrocketed following the introduction of OxyContin onto the market in the 1990s.
Methadone is an opioid drug that has been used for decades as a way to help people who are addicted to drugs in the same family. It can reduce cravings and prevent withdrawal. Methadone is available at specialized clinics, but it can also be given through doctors or pharmacists. Injectable diacetylmorphine is often used as a second-line treatment if methadone fails. But many European studies have suggested it may be an important way to combat addiction.
Purdue Pharma, the company that makes OxyContin, has phased the product out of Canada and replaced it with OxyNEO, a formulation that is supposed to be tamper-resistant (thus preventing addicts from snorting and injecting it). However, many provinces have said they are cutting public funding for the drug because of the problems that have been linked to it.
Other opioids remain on the market, and many addiction specialists predict that addiction rates of those will rise as a result of the decision to pull public funding for OxyNEO.
Researchers used data from the North American Opiate Medication Initiative. It followed people who were taking either methadone or diacetylmorphine for addiction, to determine the long-term cost-effectiveness of each. Using a mathematical model, they determined that diacetylmorphine is superior to methadone.
Based on projections from the model, an average individual in a methadone program would live 14.54 years – less than nine years in treatment, and about five and a half years in relapse, costing society about $1.14-million in health-care, criminal justice and other costs. An average individual taking diacetylmorphine treatment would live 15.43 years – nearly 10 and a half years in treatment and four in relapse, costing society roughly $1.1-million.
Although the difference may seem small, the ability of a drug-treatment program to lengthen life and reduce costs is significant, said Aslam Anis, study author and director of the Centre for Health Evaluation and Outcome Sciences at Providence Health Care Research Institute in Vancouver. "Any gain is good," he said. "How that gain happens is also very important."
For instance, an individual who receives diacetylmorphine and is able to avoid abusing drugs for a longer period than someone taking methadone can contribute to society and have a much higher quality of life during that period.
The study doesn't examine what may make diacetylmorphine preferable to methadone. But other research has arrived at similar conclusions. A Vancouver-based study published in the New England Journal of Medicine in 2009, which Dr. Anis was also involved in, found diacetylmorphine much more effective for treating opioid addiction. Specifically, among those taking diacetylmorphine, the rate of retention in addiction-treatment programs was about 88 per cent; it was 54 per cent in the methadone group.
However, diacetylmorphine can pose a serious risk of overdose and seizures, which means patients who receive it should be closely monitored.
Dr. Anis, who is also a professor in the School of Population and Public Health at the University of British Columbia, said that this research provides, for the first time, comprehensive data that policy-makers could use to assess whether current opioid-addiction treatments revolving around methadone are sufficient, or if changes are warranted.
Carly Weeks