Painkiller an option for heroin addiction: study

By Martha Kerr

NEW YORK (Reuters Health) - Scottish addiction medicine specialists report "good evidence" that the prescription painkiller dihydrocodeine can be an effective substitute for methadone for treating people addicted to heroin. Dihydrocodeine costs less than methadone and is also safer to use, they note.

Dihydrocodeine causes more of a "high" than methadone. "This is part of its value as an alternative," Dr. J. Roy Robertson of the University of Edinburgh, Scotland, told Reuters Health. "Some people see this as a disadvantage but we would not."

In addition, "dihydrocodeine does seem to have a (lower) toxicity factor and therefore there is less need for tight control." Robertson added.

In the study, 235 heroin addicts were randomly allocated to either methadone or dihydrocodeine. Patients attended Edinburgh's Community Drug Problem Service or were under the care of their family doctor.

There was improvement in both groups in outcomes, such as illicit drug use, injecting drug use and overdoses, reported crime (including drug dealing), physical and mental health, and employment or enrollment in school.

Moreover, after an average of 42 months, there were no significant differences between the two groups in terms of "retention in the drug treatment program," the primary objective.

The retention rate for all patients was 89 percent. Robertson speculated that the high rates might be attributable to relatively high doses of methadone or dihydrocodeine used in this study.

"There are many patients who do not tolerate methadone or for other reasons do not want it (too much stigma and intolerable side effects)," Robertson commented. He pointed out that some patients might need "a more flexible regimen, such as people who work or travel, are on holidays, etc. Patients sometimes go to countries where methadone is not legal, for example, Greece, and may want to avoid the scrutiny of authorities here and abroad."

Robertson and his colleagues argue that "matching the patient to the treatment through therapeutic testing or informed patient choice is widely practised, and this study suggests that it should be also available to all opiate-dependent patients in treatment."

SOURCE: Addiction, December 2006.