By Randy Shore
Canada - Using heroin to treat relapsed heroin users is more cost-effective than traditional methadone maintenance, according to a new study based on North America's only clinical trial of medically prescribed heroin.
A mathematical analysis using data from the North American Opiate Medication Initiative (NAOMI) found that addicts prescribed heroin were less likely to relapse than those taking methadone and spent less time in relapse, which reduced their lifetime costs for health care and criminal justice and extended their lives.
The study by researchers from the University of B.C. and Providence Health Care was published Monday in the Canadian Medical Association Journal.
Addicts in methadone treatment generate an average life-time cost to society of $1.14 million, compared to $1.09 million for an addict in heroin treatment, according to Aslam Anis, director of the Centre of Health Evaluation and Out-comes Sciences.
Most of the savings are realized when addicts are on maintenance and not involved with criminal behaviour, he said. The savings realized for male addicts are particularly profound.
Maintaining 2,000 male addicts between the ages of 26 and 35 on diacetylmorphine (heroin) rather than methadone generates a net savings of $156,334,060 over their lifetime, according to the webbased NAOMI savings calculator developed by CHEOS. Maintaining 2,000 females in the same age range generates $27,417,520 in savings.
The extra cost of heroin maintenance - $14,891 a year versus $3,192 for methadone - is greatly outweighed by savings in medical and criminal justice expenses, Anis said.
More than 12,000 people were on methadone maintenance in British Columbia in 2010, according to the Centre for Addictions Research of B.C. Up to 25 per cent of addicts are considered resistant to methadone treatment.
The NAOMI study con-ducted in Vancouver and Montreal between 2005 and 2008 recruited addicts who had already relapsed from methadone treatment at least twice.
Addicts in the study who were prescribed heroin rather than methadone were more likely to stay in treatment and more likely to quit heroin altogether than addicts on methadone maintenance. The findings were published in The New England Journal of Medicine.
The new study included extensive information gathered on NAOMI participants' use of the medical system to complete a complex mathematical extrapolation.
The health outcomes for addicts who stay on maintenance methadone and heroin are similar; the difference comes when addicts relapse. During the relapse period, addicts are more likely to be exposed to HIV and hepatitis and to engage in criminal activity, which adds to their lifetime medical treatment costs and shortens their lives, he explained.
"When they are in treatment it doesn't matter which medication they are getting," he said. "[Those on maintenance] were committing very little crime and there was very little cost to the justice system from incarceration."
Most of the savings to be accrued by a heroin maintenance program would be in justice costs outside the silo of health care, making the extra burden to the health care system of more expensive treatment challenging for governments and policy-makers to justify.
"We don't have the resources to pay for everything we would like in the health care system, but interventions like this would save money," said Anis. "I think it's a no-brainer."
Former NAOMI participant Mark Fraser said the prescribed heroin program improved his health and freed him from the daily grind of chasing drug dealers. "It gave me so much time to take care of myself and to get work sorted out," he said. Fraser, 47, is employed in building maintenance on the city's Downtown Eastside.
Like many addicts, Fraser was forced to deal drugs on the side to support his habit. "When the NAOMI program ended, it forced me back into the criminality of using," said Fraser. "I was forced to do things I didn't want to do."
Fraser is now enrolled in the SALOME drug trial, which will attempt to transition heroin users to oral Dilaudid.
Canada - Using heroin to treat relapsed heroin users is more cost-effective than traditional methadone maintenance, according to a new study based on North America's only clinical trial of medically prescribed heroin.
A mathematical analysis using data from the North American Opiate Medication Initiative (NAOMI) found that addicts prescribed heroin were less likely to relapse than those taking methadone and spent less time in relapse, which reduced their lifetime costs for health care and criminal justice and extended their lives.
The study by researchers from the University of B.C. and Providence Health Care was published Monday in the Canadian Medical Association Journal.
Addicts in methadone treatment generate an average life-time cost to society of $1.14 million, compared to $1.09 million for an addict in heroin treatment, according to Aslam Anis, director of the Centre of Health Evaluation and Out-comes Sciences.
Most of the savings are realized when addicts are on maintenance and not involved with criminal behaviour, he said. The savings realized for male addicts are particularly profound.
Maintaining 2,000 male addicts between the ages of 26 and 35 on diacetylmorphine (heroin) rather than methadone generates a net savings of $156,334,060 over their lifetime, according to the webbased NAOMI savings calculator developed by CHEOS. Maintaining 2,000 females in the same age range generates $27,417,520 in savings.
The extra cost of heroin maintenance - $14,891 a year versus $3,192 for methadone - is greatly outweighed by savings in medical and criminal justice expenses, Anis said.
More than 12,000 people were on methadone maintenance in British Columbia in 2010, according to the Centre for Addictions Research of B.C. Up to 25 per cent of addicts are considered resistant to methadone treatment.
The NAOMI study con-ducted in Vancouver and Montreal between 2005 and 2008 recruited addicts who had already relapsed from methadone treatment at least twice.
Addicts in the study who were prescribed heroin rather than methadone were more likely to stay in treatment and more likely to quit heroin altogether than addicts on methadone maintenance. The findings were published in The New England Journal of Medicine.
The new study included extensive information gathered on NAOMI participants' use of the medical system to complete a complex mathematical extrapolation.
The health outcomes for addicts who stay on maintenance methadone and heroin are similar; the difference comes when addicts relapse. During the relapse period, addicts are more likely to be exposed to HIV and hepatitis and to engage in criminal activity, which adds to their lifetime medical treatment costs and shortens their lives, he explained.
"When they are in treatment it doesn't matter which medication they are getting," he said. "[Those on maintenance] were committing very little crime and there was very little cost to the justice system from incarceration."
Most of the savings to be accrued by a heroin maintenance program would be in justice costs outside the silo of health care, making the extra burden to the health care system of more expensive treatment challenging for governments and policy-makers to justify.
"We don't have the resources to pay for everything we would like in the health care system, but interventions like this would save money," said Anis. "I think it's a no-brainer."
Former NAOMI participant Mark Fraser said the prescribed heroin program improved his health and freed him from the daily grind of chasing drug dealers. "It gave me so much time to take care of myself and to get work sorted out," he said. Fraser, 47, is employed in building maintenance on the city's Downtown Eastside.
Like many addicts, Fraser was forced to deal drugs on the side to support his habit. "When the NAOMI program ended, it forced me back into the criminality of using," said Fraser. "I was forced to do things I didn't want to do."
Fraser is now enrolled in the SALOME drug trial, which will attempt to transition heroin users to oral Dilaudid.
