Measured Heroin vs. Methadone Tx

[oryxandcake]

Recent research has indicated prescribed heroin may be more effective in harm reduction and addiction management as opposed to methadone maintenance therapy as can be seen here: http://press.thelancet.com/riott.pdf

Any thoughts about these findings? I practice in Vancouver where we have a number of chronic heroin users with complex medical histories. Methadone is common at my place of work and has seen some success. Here we have a supervised injection site which has met with significant controversy but has managed to stay open. We also had a NAOMI study here which had similar results with the recent UK Lancet article.

I suspect there will be hesitancy from the federal gov't - but in Canada, health policy is primarily managed by the province and there is a lot of pressure to address our growing homeless/addiction population.

Anyhow, just curious about what other people think about the research and its implications.

Thanks!

[Whispera, MSN, RN]

I skimmed the article so I might have missed something. That being said, the study was aimed at seeing if injected-at-a-clinic heroin would prevent the patients from getting street heroin as opposed to getting methadone at the clinic? So...it's a maintenance program rather than a weaning-from-heroin program?

Anyway, methadone is expensive. I don't know what heroin costs if you buy it from a pharmaceutical company rather than on the street, nor how it compares in price to methadone, pharmaceutically-provided or street-purchased. Let's say heroin is less expensive. Getting it NOT on the street would make it less likely to be mixed with other things, and make the act of taking it less likely to bring other problems with it (dirty needles, etc.). What if it's more expensive and the patient has to pay for it? Lots of people can't afford to go to a methadone clinic. One near me charges $250 a visit and insurance won't pay for it. Is this more than an on-the-street dose? Will they be able to pay for the heroin in the clinic? How will the costs be passed on to the public for the heroin compared to how they're passed on now for methadone?

I think there are a few factors the public will object to: 1)Heroin has a huge stigma as do the people who use it--the general public isn't likely to support giving it to people, no matter what it costs. Methadone has a smaller stigma attached to it. 2)People aren't going to want to have to pay to support other people's addiction.

Personally, I think if it works, increases safety for the patients, and is comparable or better in price than the methadone...it's worth trying.

[HM2VikingRN, RN]

The VA budgets 38k/year for methadone pts........I am all in favor of trying some alternatives out for improved effectiveness and lower costs.

[Whispera, MSN, RN]

to HM2...$38K per patient? $38K per facility? $38K for everyone everywhere?

[oryxandcake]

Yes, the study is focused on reducing street drug use. Along with the NAOMI study - which, focused on a similar population and evaluated measured heroin injection, they both show indications of measured heroin being effective in reducing street drug use.

In terms of methadone cost, it is difficult to compare because in Canada methadone is covered by our health care system. A report from BC, Canada, indicates it costs approx. 6,000 $/year on average to treat with methadone (http://www.bcpharmacists.org/library/H-Resources/H-4_Pharmacy_Resources/5058-Methadone_Maintenance_Program_Overview.pdf)

I think it may be quite beneficial from a harm reduction stand point - less likely to have shared needles, decrease risks for communicable diseases and if it is through nurse supervision, less chance of ODing and more opportunities for education.

I spoke with a doctor at my clinic about it and he was fairly optimistic about changes being made to adopt this practice in BC. While I do agree it will meet with resistance - especially when phrased as treating addiction with an addictive substance. The cost of addiction and its byproducts are significant and hopefully, policymakers will pay attention. Anyhow - if you're interested in reading more, check out this link: http://www.naomistudy.ca/pdfs/naomi_background.pdf

[elkpark]

While I do agree it will meet with resistance - especially when phrased as treating addiction with an addictive substance.

But that's what methadone treatment is, also -- simply replacing the illicit short-acting opiate with a legal, long-acting opiate. Methadone maintenance tx doesn't do anything to treat or "fix" the addiction, just maintains the addiction with a different addictive substance (although methadone can be used to taper people off of opiates, which is actual treatment of the addiction -- but that's different from methadone maintenance tx). It's just that most of the public doesn't realize that's how it works, they think methadone is something different that is treating/curing the addiction ...

In my experience (working with addicts, that is ), street heroin is much cheaper than methadone. I have no idea how much "pharmaceutical grade" heroin would cost, but it would have to be pretty darned expensive to cost more than methadone. I'm not a fan of methadone maintenance treatment anyway (despite all the regulation, many of the clinics are v. corrupt and little more than scams), and, if it would be less expensive to shoot people up with heroin, I don't see a downside. Society ends up paying for it anyway, either way, so I vote for whichever system is more cost-effective.

[HM2VikingRN, RN]

to HM2...$38K per patient? $38K per facility? $38K for everyone everywhere?

per patient....That pays for meds, utox's, nurses, doctors, facility costs....