Could treating heroin addicts with heroin really work?

According to a new study published in the August 20 New England Journal of Medicine, it is a possibility. The research conducted by researchers at the University of British Columbia and the Université de Montréal showed that heroin addicts who failed at least two previous treatment attempts faired much better in rehab when allowed to self-administer heroin under medical supervision at the study clinics.

The study results shows that “nearly 88 percent of heroin-treated patients remained in the treatment at the end of one year,” which is significantly higher than the 54 percent retention rate for methadone-treated patients. The researchers also found that 67 percent of heroin-treated patients reduced their illegal drug use met the criteria for responders in terms of reduced illicit-drug use or illegal activities throughout treatment.

But this study raises some potential questions and concerns. Will treating heroin users with heroin actually help patients quit or just diminish the quantities they inject? And is it ethical to use such a highly addictive drug as a treatment?

Victoria Stern,
editorial intern
The Scientist

other than the fact that heroin is illegal, I don't see how treating heroin addiction with supervised administration of heroin is all that different from treating nicotine addiction by means of a nicotine patch. The main difference between heroin and nicotine is that one alters your behavior & physiology in much more obvious and dangerous ways than the other in the short term, but both drugs are highly addictive and have a very high relapse rate, so anything that can help to withdraw an addict from the drug in question in a safe and permanent manner is beneficial, IMHO.

I should add, in neither case do the majority of addicts benefit from treatment unless there is a supportive environment that actively engages the user in behavioral modification.

Where exactly is this "ethical" dilemma besides in the minds of the US Drug Policy International Police.

Every one of your readers is familiar with the use of the "nicotine patch" or a similar modality which uses a highly addictive drug to treat addiction to that drug. The only difference here is that the drug involved is considered immoral by the people with so much invested in maintaining the "drug wars".

Isn't it time they finally learned the lesson of the US prohibition era - which is that government control of the means of distribution and manufacture is far more successful as a crime eliminator than phony wars on substances, and it can also produce tax revenue.

It's time Elliott Ness was returned to his grave.

This seems to work best for alcoholics, too. Controlled, moderate drinking reduces overall consumption and bad behavior better and for longer than quitting cold turkey.

For me, the question about this method of "treatment" is "what problem are you trying to solve?" Is it to reduce or eliminate the dependence on the drug per se? Or is it to reduce or eliminate the anti-social activities (theft, assault, and so forth) that an addict resorts to in order to obtain the drug of choice? If the problem is the first, then I'm not sure if giving heroin to junkies will solve the problem. However, if it's the second, then a satisfied junkie won't need to steal to support the habit, and that problem would be solved. (Also, if sterile works are routinely used, the transmission of blood-borne pathogens is also reduced.)

I don't see why it shouldn't work. That is if you include death as part of the definition of a cure for heroin. Seems to me that the body could build some level of immunity to certain "poisons", but not all. I just don't think heroin could be cured this way.

People do develop tolerance to drugs of all kinds, including heroin. What kills most heroin addicts is impurities in the drug, or overdose. Either one should be avoidable under medical supervision. I realize we're all conditioned to look at heroin as evil but it's not inherently evil any more than any other substance is. The difficulty with heroin addiction lies in the dramatic physiological and psychological changes this substance causes... but that's the SAME difficulty that arises with nicotine, alcohol, cocaine, even sugar. So if you take away the prejudices that surround the drug and the socio-cultural meaning it has and look at it strictly as a biochemical problem, there's no reason that this strategy shouldn't work.

Of course, we're all humans and you cannot completely strip away the socio-cultural aspect of the use of this drug. That's why I said support & rehab are essential.

Speaking as a former longtime heroin addict, this makes a lot of sense to me. It would enable heroin addicts to lead productive lives by eliminating the endless struggle to obtain the day's hit, and by removing them from social context of heroin use. In my experience, the mere fact of attaining some stability in life allows addicts to focus more energy on recovery.

One thing that tends to get overlooked in these discussions is the importance of the treatment environment. The high dropout/relapse rate for methadone treatment programs has much to do with the extremely negative and stressful nature of so many methadone clinics. It's hard to stick with any program that requires one to face demeaning and even abusive treatment at every visit. So for this type of program to be effective, great care would have to be taken that treatment centers did not devolve into the "legal dope house" stereotype that all too many methadone treament programs fit.

I am curious as to what kind of taper schedule the subjects were placed on, whether it was self-regulated or not, and whether there was any pressure or incentives to begin or accelerate taper-downs.

Regarding the comment about "immunity to certain poisons": Heroin addicts do not die because heroin is "poison". If heroin and related opiates were "poison", they could not be used as they are in standard medical practice. Most heroin-related deaths occur because heroin is illegal and thus has no quality control or product labeling. Likewise, the social issues associated with heroin are those that occur with just about any commodity subject to black-market pricing and distribution structures.

As for ethics... as I see it, anything is more ethical than just writing off a whole population as worthless criminals. The question of ethics seems to derive more from the longtime demonization of heroin and its users than anything else.

How does the alcohol aspect work. Is it a serotonin issue?

Kudos to you Hille! You said it better than anyone.

I wish this message could make it into the general populace so we could wake up to the fact that imprisoning our addicts isn't helping them (or us) any. I have a brother serving hard time in the federal pen largely because he's been a drug user since the age of 13, and while he did get some support during his time in state prisons--enough to keep him mostly clean--once in the federal system, that support vanished and he went back to drugs. It's apparently easier to get drugs in the federal pen than it is on the street. I keep wondering whether he might have had a more useful and productive life if treatment of his addiction to alcohol and marijuana had been given greater emphasis during his initial 3-year term.

I love scotch...but only drink 12 year single malt. I'll seek treatment when a cask of 12 year Glenlivet is put into a clinic. The heroin users and I could even have a party.

PaulTS41560 wrote:" Is it to reduce or eliminate the dependence on the drug per se? Or is it to reduce or eliminate the anti-social activities (theft, assault, and so forth) that an addict resorts to in order to obtain the drug of choice?

I agree with Paul and Hille regarding the struggle to obtain the drug and the effect in the stability of their lives. But I don't think it will eliminate the dependence of the drug, and isn't that supposed to be the goal of rehab. clinics?

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