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Unique research finding : Majority of heroin addicts can be treated

May 15, 2002

Unique research finding at Karolinska Institutet and the Maria Clinic in Sweden shows that a majority of heroin addicts can be treated with a combination of drugs and psychological therapy.

A study of heroin addicts that were treated with the drug buprenorfin in combination with group therapy, a contact officer, and drug testing showed excellent results. Fully 75% of the addicts receiving the drug remained on the treatment program after one year as opposed to 0% of a control group that received a placebo alongside the other treatment components. Among those patients still in treatment drug abuse has declined dramatically or ceased, and their social function has improved markedly.

Narcotics-related problems and mortality are increasing rapidly in Sweden, with more than 300 deaths in 2001. Heroin accounts for the highest rate of mortality. Maintenance treatment with methadone (MUB) has a documented effect on heroin addiction, according to a recently released report from the Swedish Council on Technology Assessment in Health Care. However, MUB entails certain disadvantages and should be reserved for the most severe cases of addiction in which other methods of treatment have failed. There is therefore a great need for a "first line of treatment." If such a method can be developed, then it will hopefully be possible to rein in the development of addiction, thus reducing the need for MUB. Today, however, there are no forms of treatment documented as effective for heroin addicts apart from MUB.

Buprenorfin is a drug that has preliminarily proven to be effective for heroin addiction. The preparation has been registered in Sweden since 1999. Buprenorfin does two things:

-It activates opiate receptors in the brain, but to a limited extent (in contrast with heroin and methadone, which do so fully), therefore reducing or eliminating the craving for heroin.
-If the patient relapses as a matter of habit to heroin abuse, the opiate receptors will be blocked, and the expected high will not happen.

Previous buprenorfin studies have been short-term (3-6 months), have not involved modern psychological treatment, and have not monitored patients' social function. Most studies have been American. In connection with a scientific conference in Oslo, Norway, May 14-16, the results will be presented from a Swedish controlled study that was recently concluded at the Karolinska Institute and the Maria Clinic by Associate Professor Markus Heilig, chief physician Johan Kakko, and Research Nurse Kerstin Dybrandt. Forty heroin addicts were all invited to take part in abuse-oriented group therapy rooted in cognitive behavioral therapy, one meeting per week with a contact officer, and drug testing three times a week. Half of the patients were also randomly selected to take a daily dose of 16 mg of buprenorfin under supervision, while the other half were given a placebo. The procedure was doubly blind, that is, neither those administering the treatment nor the patients knew which group each individual belonged to. The patients were followed up for one year.

The prime measure of success in this type of study is the degree to which patients remain in the program, since, in the absence of treatment, 90-100% of heroin addicts will relapse within a year and will break off any contact. Those patients remaining in the program were tested for drug abuse using objective methods, and every third month their social function (including criminal behavior, housing situation, and gainful employment) was examined using standardized interviews. A preliminary analysis of the data shows that 75% of the buprenorfin-treated patients were still under treatment after one year. The corresponding figure for the control group was 0%. Among patients who remained in the program, drug abuse dropped dramatically or ceased, and their social function improved markedly. Patients who completed the one-year study have successfully continued their treatment since, and several of them have carried on for more than two years. According to the researchers, the study is only the second controlled treatment study in the field of narcotics ever carried out in Sweden. The outcome is unique in the world and clearly indicates that there is no cause for despair in the struggle against narcotics abuse.

Vetenskapsrådet (The Swedish Research Council)