News Release

Treatment with buprenorphine should be widespread to reduce heroin dependency problems

Peer-Reviewed Publication

The Lancet_DELETED

Treatment with buprenorphine increases the time heroin addicts remain abstinent and the time taken for them to relapse compared with naltrexone and placebo. Thus maintenance treatment with buprenorphine could be widely disseminated as an effective public-health approach to reduce problems associated with heroin dependence. These are the conclusions of authors of an Article published in this week's edition of The Lancet.

Dr Richard Schottenfeld, Yale University School of Medicine, New Haven, CT, USA and colleagues did a randomised controlled trial to compare the efficacy of naltrexone (a standard treatment), buprenorphine, and placebo in patients receiving detoxification and subsequent drug counselling. They analysed maintenance of heroin abstinence, prevention of relapse, and reduction of HIV risk behaviours. 126 detoxified heroin-dependent patients, from an outpatient research clinic and detox programme in Malaysia, were randomly assigned to 24 weeks of manual-guided drug counselling and maintenance with naltrexone (43 patients) buprenorphine (44), or placebo (39).

The researchers found that for days to first heroine use, days to heroin relapse (three consecutive positive urine tests) and maximum consecutive days abstinent, all results were best for buprenorphine and worst for placebo.

Patients given buprenorphine lasted nearly twice as long until first heroin use compared with naltrexone and just over twice as long as those given placebo. Compared with placebo, patients given buprenorphine lasted more than twice as long to first heroin relapse and also had more than twice as many continuous days of heroin abstinence. But differences between buprenorphine and naltrexone in these two outcomes were not statistically significant. HIV risk reduction behaviours significantly reduced from baseline across all three groups, mainly due to decreased injected drug use, but there were no significant differences between the three groups.

The authors conclude: "Our findings lend support to the widespread dissemination of maintenance treatment with buprenorphine as an effective public-health approach to reduce problems associated with heroin dependence."

In an accompanying Comment, Dr Wayne Hall, School of Population Health, University of Queensland, Australia, and Dr Richard Mattick, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia, say that health authorities in developing countries should no longer restrict pharmacological treatment of opioid dependence to oral naltrexone, and that the preferred treatment should be maintenance with either methadone or buprenorphine.

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Dr Richard Schottenfield, Yale University School of Medicine, New Haven, CT, USA T) +1 203-974-7349 E) richard.schottenfeld@yale.edu

Dr Wayne Hall, School of Population Health, University of Queensland, Australia T) +61-7-3365-5330 E) w.hall@sph.uq.edu.au

http://multimedia.thelancet.com/pdf/press/heroin.pdf


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