Naltrexone for heroin addiction

Heroin addicts are often prescribed methadone as this reduces problems with criminality, contaminated drugs and dirty needles. However, methadone itself is still addictive so Nikolaj Kunoe from the Norwegian Centre for Addiction Research at the University of Oslo looked into the use of a substance called naltrexone. Naltrexone completely blocks the effects of heroin and other morphine-related substances. Kunoe studied 56 heroin addicts who had already been through detoxification treatment. Half of them were implanted with 20 subcutaneous pellets containing naltrexone which was gradually released into the bloodstream and half received treatment as usual. After six months twice as many people in the naltrexone group managed to give up heroin and those who did not give up heroin more than halved their use. By contrast in the control group the majority of people relapsed back into heroin use.

Implant could help heroin users

Researchers from the University of California, Los Angeles have been studying the effectiveness of implants in improving the lives of heroin addicts. The implants are inch-long rods that sit just underneath the skin on people's arms. They last for six months and release a steady trickle of buprenorphine, an anti-addiction medicine which is chemically-related to heroin but less harmful. The study involved 163 participants, half of whom received dummy implants and half of whom received buprenorphine ones. After four months urine samples showed that 40% of those with the buprenorphine implants tested negative for illegal drugs compared to only 28% of those with the dummy implants. The drug did have side effects such as nausea, vomiting and constipation.

Study backs use of methadone

Methadone is often used as a substitute for heroin in drug-treatment programmes, the idea being that it stops users from stealing to pay for their drug habit and stops them from overdosing, using contamintated heroin and storing dirty needles. Defenders of methadone say that it cuts crime and reduces the danger to addicts while opponents say that drug users are just 'parked' on methadone without moving on to rehabilitation programmes. Researchers from Edinburgh University studied 800 heroin users, of whom 571 were still alive when the research was followed up. The study found that methadone treatment reduced the frequency of drug use and led to a drop in the risk of death by 13% each year. The drug did not prolong the number of years users continued to inject heroin but those who took it led less chaotic lives and lived for longer. Overall the researchers concluded that "suggestions that methadone prescribing should be cut back or confined to the short-term are clearly misplaced and would lead to poorer health for drug injectors."

You can find out more about this research at

http://news.bbc.co.uk/1/hi/scotland/edinburgh_east_and_fife/10558740.stm

Long-lasting naltrexone for heroin addicts

A drug called naltrexone is used to treat heroin addicts as it blocks the receptors heroin uses to generate its effect. Unfortunately the effectiveness of naltrexone can be limited as people often forget to take it orally. One way round this problem is to use a long-lasting injection which delivers the drug gradually into the bloodstream. A team of researchers from Australia compared the effectiveness of a long-lasting injection with that of oral naltrexone in a study of 70 heroin addicts. As well as comparing the injections to oral naltrexone the researchers also compared both treatments to a placebo. The study found that the implant led to higher levels of the drug in people's bloodstreams, fewer people returning to heroin use and people going longer before relapsing.

Hulse, Gary K. ... [et al] - Improving clinical outcomes in treating heroin dependence Archives of General Psychiatry October 2009, 66(10), 1108-1115

Diacetylmorphine for heroin addicts

Methadone is often given to heroin addicts as a way of reducing crime, infection and the risk of an overdose. However, methadone fails in 15-25% of cases. Researchers from the University of British Columbia looked into the effectiveness of diacetylmorphine - the active ingredient of heroin - in a study of 226 addicts in Montreal and Vancouver. Only 54% of those who received methadone stayed in a treatment for a year, compared to 88% of those who received diacetylmorphine. Those who received diacetylmorphine cut back on illegal drugs by 67% compared to a 48% reduction in those given methadone. Only 5.4% of those receiving methadone and 0.9% of those receiving diamorphine committed crime compared to three-quarters of those receiving neither.

You can find out more about this research at

http://uk.reuters.com/article/idUKTRE57I65420090819?feedType=RSS&feedName=healthNews&sp=true

What do heroin addicts want and fear? The same as everyone else

Many current theories about drug addiction suggest that addicts are motivated to take drugs by a desire to experience the pleasure they get by taking them and a fear of experiencing the unpleasant withdrawal symptoms of stopping taking them. Several studies have found that the use of alcohol and other addictive drugs is increased when access to other pleasures is reduced and, conversely, when the availability of other pleasures is increased drug use declines. Other theories look at why people start taking drugs in the first place. One theory is that people's views about the rewards of various activities and the costs associated with them come from their families in their childhood and their peers during their adolescence when people are vulnerable to falling in with a bad lot. According to this theory drug addicts should have a very different view of the rewards and costs of different activities than other people. Researchers from the South Essex Parnership NHS Trust and Cambridge University examined this theory by comparing 104 heroin addicts with 104 members of the general public. Both groups were asked to rate 21 pleasurable activities and 22 damaging and disruptive conditions in order of importance. The drug addicts reported that they got more pleasure from children, friends, sex and a good meal than heroin and they rated heroin addiction as the second most damaging and disruptive condition after lung cancer. The rankings of both groups were highly comparable and the researchers concluded that the values and priorities of the heroin addicts were very similar to those of the general population.

Luty, J. and Lawrence, A. - Preferred activities of opiate dependent people Journal of Substance Use February 2009, 14(1), 61-69

Heroin clinics help users and neighbourhoods

Heroin is sometimes provided to drug addicts at medically-supervised clinics as this is thought to lessen the risk of overdose, and of picking up infections such as hepatitis C. One such initiative is the NAOMI project - the North American Opiate Medication Initiative. Researchers at the University of Montreal looked at the impact of the NAOMI project on the surrounding areas. They found no evidence of an increase in criminal acts or deviant behaviour and a decrease in the quantity of drug-injecting debris such as syringes, needle covers, spoons etc. Participants in the project reduced their consumption of illegal drugs by 70%, their criminal activity by 36% and improved their health (measured by the scores on a questionnaire) by 20%.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/02/090217141524.htm

Anhedonia and drug addiction

Anhedonia - the inability or failure to experience pleasure - is a common characteristic in drug addiction. One theory is that the drugs raise the brain's threshold for feeling pleasure so that, for example, a cup of tea and a couple of chocolate biscuits no longer have the same effect, and that this threshold does not return to normal even after people have given up taking drugs. A study of 52 people by researchers at the University of Melbourne compared 33 people being treated for heroin addiction with 19 healthy controls. Participants were shown pictures of pleasant stimuli and drug-related stimuli and their reactions to them were measured using a range of physiological methods. The heroin users demonstrated a reduced responsiveness to the pleasant stimuli and an increased response to the drug-related stimuli. How the drug users reacted to the stimuli was a significant predictor of heroin use at a six-month follow-up.

Lubman, Dan I. ... [et al] - Responsiveness to drug cues and natural rewards in opiate addiction Archives of General Psychiatry February 2009, 66(2), 205-213

New treatment shows promise for opioid addiction

Opioids include a wide range of drugs such as codeine, morphine and heroin. Some are completely illegal, while others are legitimate prescription drugs open to abuse. One of the main factors preventing people from seeking treatment for opioid addiction is the terrible withdrawal symptoms caused when people stop taking the drugs: agitation, insomnia, diaorrhea, nausea and vomiting. Of the current drugs used for treating withdrawal symptoms clonidine can have severe side effects and methadone and buprenorphine can themselves be addictive. The drug ondansetron, which is already used to treat nausea and vomiting, blocks the receptors that are involved in maintaining opioid addiction and trials on mice have proved promising. A very small-scale study on humans also showed encouraging results.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/02/090217212255.htm

Methadone and buprenorphine

Methadone is the usual treatment for heroin addicts. It improves physical and mental health and social functioning and reduces criminal behaviour. However, people can die of an overdose of methadone and some people argue that it prolongs the period of dependence as it takes a long time to come off it. In 1999 buprenorphine was licensed for use in treating heroin addiction. It is less harmful in overdose and easier to withdraw from although methadone is slightly more effective and significantly cheaper. However, little is known about the views of heroin addicts themselves on methods of treatment. A study of 42 addicts in Norwich found that those taking buprenorphine viewed methadone more negatively and buprenorphine more positivelythan those taking methadone. Those taking methadone apperared to do do on the basis of familiarity whereas those taking buprenorphie appeared to be attracted by their beliefs that it would block heroin more effectively, reduce cravings, give less intoxication and be earlier to stop taking than methadone.

Pinto, H., Rumball, D. and Holland R. Attitudes and knowledge of substancd misusers regarding buprenorphine and methadone maintenance therapy Journal of Substacke Use Janray 2008, 13(3), 143-153