Heroin may be more effective than methadone for relapsing addicts

Diacetylmorphine, or heroin, may be a more effective treatment than methadone for people with relapsing chronic opioid dependence, according to a study published in the Canadian Medical Association Journal.

Aslam Anis, PhD, director of the Centre for Health Evaluation and Outcome Sciences at St. Paul’s Hospital in Vancouver, and colleagues, stated that studies have shown that diacetylmorphine is more effective than methadone maintenance treatment in keeping opioid-dependent patients in treatment; however, they noted that there are political challenges as well as concerns that the treatment could cost up to 10 times more than the conventional methadone therapy.

To assess the long-term cost-effectiveness of diacetylmorphine versus methadone maintenance treatment, the researchers extrapolated outcomes from the North American Opiate Medication Initiative using a mathematical model (semi-Markov).

The model aimed to capture the cycles of treatment, relapse, and abstinence observed in long-term observational studies of opioid-dependent individuals, the authors said, and considered time horizons of 1, 5, and 10 years as well as the lifetime to project costs and outcomes over the expected duration of treatment and its effects.

In each time horizon, the researchers found heroin to be the dominant strategy. Over a lifetime horizon, people receiving methadone lived 14.54 years on average following entry into the model, and they spent 8.79 years (60% of their remaining life) in treatment and 5.52 years in relapse. Those receiving methadone also gained an average 7.46 discounted quality-adjusted life-years (QALY) and generated a societal cost of $1.14 million.

Patients receiving the heroin lived 15.45 years on average, and they spent 10.41 years (67% of their remaining life) in treatment (2.34 years of which was in post-diacetylmorphine methadone treatment) and 4.05 years in relapse. They gained an average 7.92 discounted QALYs and generated a societal cost of $1.10 million.

“Our model indicated that diacetylmorphine would decrease societal costs, largely by reducing costs associated with crime, and would increase both the duration and quality of life of treatment recipients,” the authors concluded.