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Contact:Beverly Jackson Michelle
"There are nearly one million chronic users of heroin in the United States,
and this study is important because it helps to identify the most effective
treatments for this devastating addiction," explained Dr. Alan I. Leshner,
director of the National Institute on Drug Abuse (NIDA), National Institutes
of Health, which provided funding for the research. "This study also furthers
our knowledge about the effectiveness of buprenorphine and, ultimately, it may
expand the treatment options available to physicians."
A research team led by Dr. Rolley E. Johnson at the Johns Hopkins
University School of Medicine conducted the study, published in the November 2
issue of the New England Journal of Medicine.
Dr. Johnson's team compared treatment results in 220 volunteers between the
ages of 21 and 55, diagnosed as heroin dependent. The volunteers were randomly
assigned to one of four treatment groups: LAAM, buprenorphine, high-dose
methadone (60 to 100 mg), or low dose methadone (20 mg). There were 55
patients in each group.
For all four treatment groups, reported heroin use decreased by about 90%
after entering treatment. In addition, all measures-length of time remaining
in the study, heroin use during the study, and ratings of drug problem
severity-were better for subjects in the LAAM, buprenorphine, and high-dose
methadone groups than for those in the low-dose methadone group. All three
treatments markedly reduced illicit heroin use. There was little difference in
treatment outcomes among the LAAM, buprenorphine, and high-dose methadone
treatment groups. LAAM produced the longest duration of continuous abstinence;
buprenorphine was similar to LAAM in terms of retention in the study and to
high-dose methadone in terms of abstinence.
In the 17-week study, retention rates ranged from 72.7 percent (high-dose
methadone group) to 20 percent (low-dose methadone group). LAAM,
buprenorphine, and high-dose methadone patients submitted fewer
heroin-positive urine samples than did low-dose methadone patients. The
percentage of patients with 12 or more consecutive heroin-negative urine
specimens differed significantly across the groups. More than one-third of the
LAAM patients had 12 or more consecutive negative urine specimens, while only
8 percent of the low-dose methadone patients achieved this number. The
percentage of high-dose methadone and buprenorphine patients reaching this
mark was only slightly less than the LAAM group.
Patients in the LAAM and buprenorphine groups were given these drugs three
times a week, and patients in both methadone groups received daily doses. Dr.
Johnson said that not having to administer LAAM or buprenorphine on a daily
basis gives these drugs a clinical advantage. "Less-than-daily dosing," he
says, "reduces the need for take-home medication, requires fewer clinic
visits, and allows a more normal life ."
The National Institute on Drug Abuse is a component of the National
Institutes of Health, U.S. Department of Health and Human Services. NIDA
supports more than 85 percent of the world's research on the health aspects of
drug abuse and addiction. The Institute carries out a large variety of
programs to ensure the rapid dissemination of research information and its
implementation in policy and practice. Fact sheets on the health effects of
drugs of abuse and other topics can be ordered free of charge in English and
Spanish by calling NIDA Infofax at 1-888-NIH-NIDA (644-6432) or 1-888-TTY-NIDA
(889-6432) for the deaf. These fact sheets and further information on NIDA
research and other activities can be found on the NIDA home page at http://www.drugabuse.gov/.
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