Heroin by prescription seen to help addicts quit

It sounds counterintuitive, but a Canadian study released this week showed that giving heroin to addicts may help them stop using the drug in the future.

The North American Opiate Medication Initiative (NAOMI) is the first trial of its kind in North America, and therefore the first on the continent to show that heroin-assisted therapy - providing chronic heroin addicts with controlled dosages of the drug in a medical setting - can help chronic addicts when other treatments like methadone therapy or abstinence programs haven't.

The trial's final results, released this week, showed that the therapy helped reduce illegal drug use and related crimes. Similar trials in Europe have already shown that treatment with prescribed heroin improved health, decreased illegal drug use, and decreased health costs for chronic addicts, as well as showing that the treatment generally saved more money than it cost.

"A combination of optimal therapies - as delivered in the NAOMI clinics - can attract those most severely addicted to heroin, keep them in treatment and more importantly, help to improve their social and medical conditions," said Dr. Martin Schechter, the study's principal investigator, in a statement.

The clinical trial and its results are part of a wider debate about the role of harm reduction in fighting addiction. Those opposed say the focus should be on getting addicts to stop using heroin, not providing them access to the drug. Supporters of initiatives like heroin-assisted treatment (HAT) argue that harm reduction measures help reduce the social and economic burden of addiction, both for addicts themselves and for society at large. Those burdens include crime, unemployment and diseases like HIV and Hepatitis C.

The costs of heroin addiction are substantial. Canada has an estimated 60,000 to 90,000 opiate addicts; a 2006 study from the Centre for Addiction and Mental Health in Toronto found that illegal drug use costs Canadians $8.2 billion annually. In the United States, the number of opiate addicts is more than 1 million, according to the National Institute for Drug Abuse, and is on the rise.

Heroin-assisted treatment is aimed at the most serious cases of addiction - people who have not been helped by previous treatments and are chronic heroin users. These people tend to be socially and economically isolated. The NAOMI study defined chronic addicts as people with a documented drug addiction spanning at least five years, and frequent heroin use for at least one year prior to entering the study.

European trials have studied the effectiveness of HAT, and found that it improved health status, increased employment, decreased illicit drug use and reduced criminal activity in chronic opiate addicts. HAT also puts chronic addicts, who are often socially and economically isolated, into an environment where they can receive medical care, counseling, social assistance and employment training that they otherwise couldn't access.