Recovering Addicts Fare Better on Opiate Medication, Yale Researchers Find

Heroin addicts fare better when treated with an opiate maintenance medication than one designed to block the drug’s effects, Yale University researchers reported Thursday in the journal Lancet.

In countries such as Russia, Malaysia and in some clinics in the United States, addicts are not offered maintenance treatment with medications such as methadone or the newer and less-easily-abused medication buprenorphine. Instead, addicts are given counseling only or counseling combined with medications such as naltrexone, a non-opiate drug designed to block the effects of heroin.

In the United States alone hundreds of thousands of people addicted to heroin or painkillers are not getting the most effective treatments available, said Richard S. Schottenfeld, professor of psychiatry at the Yale School of Medicine and lead author of the study.

“The study results make clear that we need to make treatment with buprenorphine or methadone more available here and abroad,” he said.

Schottenfeld and his colleagues at Yale and in Malaysia compared the efficacy of oral doses of buprenorphine and naltrexone in a randomized placebo-controlled trial.

Members of a third group were given a placebo and, like other subjects in the study, received drug counseling. The 126 addicts in the study were tested for drugs three times a week over the course of the study, which was designed to last 24 weeks.

At the end of the trial, addicts given buprenorphine had, on average, significantly longer stretches without using the drug, waited more days before they used heroin, and also had longer stretches before a full relapse of repeated drug use than those taking naltrexone or placebo.

The study was stopped after only 22 weeks because the findings so clearly showed the greater efficacy of buprenorphine, explained Schottenfeld.

Other studies previously have shown the superiority of methadone in preventing heroin relapse compared to detoxification alone or drug counseling only, Schottenfeld said, but have not compared buprenorphine and naltrexone. The Lancet study shows addicts can also benefit from treatment with buprenorphine as well methadone, he noted, adding that buprenorphine is less easily abused and poses a much smaller risk of overdose than methadone. Also, it can be prescribed by a doctor in a regular, office-based practice, which makes it both easier to provide in regions that do not have methadone clinics and a good candidate for people who are hesitant to seek methadone treatment, including many who are addicted to painkillers such as Oxycontin or Percocet, Shottenfeld said.

The National Institute on Drug Abuse funded the study.

Other authors of the study are Marek C. Chawarski of Yale and Mahmud Mazlan in Malaysia.