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An alternative drug therapy to methadone for the treatment of heroin addiction is proposed by Swedish authors of a study published in The Lancet. Methadone is an established treatment for heroin addiction - however it is usually only given to long-term addicts as there are concerns that it is addictive. Buprenorphine has been suggested for the treatment of heroin dependence, but little research has justified its effectiveness.
Markus Heilig from the Karolinska Institute, Stockholm, Sweden, and colleagues assessed the 1-year efficacy of buprenorphine in combination with intensive psychosocial therapy for treatment of heroin addiction. 40 adults who had been categorized as opiate dependent for at least a year (but who did not meet the Swedish criteria for methadone treatment) were randomly allocated either to daily buprenorphine or a 6-day regimen of buprenorphine followed by placebo.
In addition to treatment allocation, all patients participated in cognitive-behavioural group therapy to prevent relapse, received weekly individual counseling sessions, and submitted regular urine samples for analysis to detect illicit drug use.
The results were striking - three-quarters of those given buprenorphine remained in the treatment program one year later compared with none of those given placebo.
Urine samples were 75 percent free of opiates or other drugs among those given buprenorphine-suggesting that treatment was effective in reducing heroin and other drug use. The incidence of criminal activity was also reduced among these individuals compared with those given placebo.
Markus Heilig comments: "We believe that our strategy of a highly planned delivery of buprenorphine in combination with cognitive behavioral treatment, seems to offer an useful complement to methadone maintenance treatment, and should be added to treatment options for heroin dependent individuals."
In an accompanying Commentary, Fergus Law and David Nutt from the University of Bristol, UK, state: "This trial is likely to become a classic in the area. The results have far-reaching implications for the treatment of opioid dependence in general, and the role of psychological treatments and buprenorphine in particular."
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