Heroin-Assisted Treatment Model Discussed

A refractory heroin-dependent patient can expect to lose 25 years of life expectancy as a result of the addiction, a stark statistic presented by Wim van den Brink, M.D., Ph.D., during Friday’s symposium “Innovative Models of Addiction Treatment from the International Context.”

During “Heroin-Assisted Treatment for Treatment of Refractory Heroin-Dependent Patients,” Dr. van den Brink, Director of the Amsterdam Institute for Addiction Research, Academic Medical Center University of Amsterdam, reported on a possible treatment approach in light of a troublesome U.S. study published in 2001. These data showed 48 percent of heroin addicts from an average age of 24.5 to 57.4 had died during the 33-year course of follow-up data.

“Heroin addiction is a chronic, relapsing, and potentially fatal disease,” he said. “Over the long term, only 20 percent achieve stable abstinence. Things could look very differently in terms of morbidity and mortality with more effective treatment.”

While methadone is the most effective in terms of treatment retention and reduction of heroin use, clearly the approach has effectiveness limits, as does treatment with buprenorphine, Dr. van den Brink noted. That led addiction experts in the Netherlands to consider an alternative approach — heroin-assisted treatment.

Two randomized, controlled trials were conducted from 1998 to 2002 in the Netherlands using the experimental treatment of oral methadone in combination with heroin in inhalable or intravenous doses. At the end of 12 months, noticeable improvements were seen in reducing heroin use and in study participants’ physical health and mental status. Quite telling is what happened when participants came to the end of the study a year later and returned to more traditional approaches to their heroin addiction. Eighty-two percent deteriorated significantly after discontinuing heroin-assisted treatment, Dr. van den Brink said.

“Heroin-assisted treatment is an effective additional treatment option for chronic treatment-refractory cases,” he said. “It is also effective, safe, and cost-effective with positive long-term outcomes. Still, nearly 50 percent of patients are not responding to this approach. Additional treatment and care options need to be developed for these patients.”

Also addressing Friday’s symposium was Steven Gust, Ph.D., Director of the National Institute of Drug Abuse International Program.

“Drug use is reported in every country of the world, and it has a huge impact in the health sector as one of the top 20 health risk factors globally,” he said. “Injecting drug use is reported in 151 countries, and the United Nations has estimated that drug abuse costs can equal up to 2 percent of the gross domestic product. ”

A recent Institute of Medicine report recommended that the U.S. government scale up existing interventions; generate and share knowledge; invest in people, institutions, and capacity building; increase U.S. financial commitments to global health; and engage in respectful partnerships, Dr. Gust said. The National Institutes of Health supports $600 million a year in global health research.