Residential or Outpatient Treatments: Longer Treatment (90 days) Have more Favorable Outcomes.
Favorable Treatment Outcomes for Heroin Addiction are 50% more likely when Medication-Assisted Therapy is used. These studies primarily point to methadone.
There are so many studies done with varying differences in approaches, that we have included a lot of them with a short summarization of the relevant findings:
1) Amato L, Davoli, et. al., An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. Journal of Substance Abuse Treatment 2005; 28 (4):321-329. In this overview of meta-analyses and other reviews, they conclude that methadone maintenance is more effective in the treatment of opioid addiction than methadone detoxification, buprenorphine, or no treatment. Higher doses of methadone are more effective than low or medium doses.
2) Ball JC, Ross A., The Effectiveness of Methadone Maintenance Treatment. New York, NY: Springer-Verlag Inc., 1991. This landmark study included six hundred and thirty-three male patients enrolled in six different methadone maintenance programs. The best results (no heroin use) was seen in patients on doses higher than 70 milligrams. Longer duration of treatment with methadone showed the greatest reductions in heroin use. Of patients who left methadone maintenance treatment, 82% relapsed back to heroin use within one year.
3) Caplehorn JRM, Bell J. Methadone dosage and retention of patients in maintenance treatment.The Medical Journal of Australia 1991;154:195-199. This study concluded that higher doses of methadone (80 milligrams per day and above) were significantly more likely to retain patients in treatment.
4) Caplehorn JR, Dalton MS, et. al., Methadone maintenance and addicts’ risk of fatal heroin overdose. Substance Use and Misuse, 1996 Jan, 31(2):177-196. This study followed two hundred and ninety-six methadone heroin addicts for more than fifteen years. Heroin addicts in methadone treatment were one-quarter as likely to die by heroin overdose or suicide.
5) Dole VP, Nyswander ME, Kreek, MJ, Narcotic Blockade. Archives of Internal Medicine, 1966; 118:304-309. Consisted of thirty-two patients, with half randomized to methadone and the other half to a no-treatment waiting list. The methadone group had much higher rates of abstention from heroin, much lower rates of incarceration, and higher rates of employment.
6) Faggiano F, Vigna-Taglianti F, Versino E, Lemma P, Cochrane Database Review, 2003 (3) Art. No. 002208. This review article was based on a literature review of randomized controlled trials and controlled prospective studies that evaluated the efficacy of methadone at different doses. The authors concluded that methadone doses of 60 – 100mg per day were more effective than lower doses at prevention of illicit heroin and cocaine use during treatment.
7) Goldstein A, Herrera J, Heroin addicts and methadone treatment in Albuquerque: a year follow-up. Drug and Alcohol Dependence 1995 Dec; 40 (2): p. 139-150. This study followed a group of heroin addicts. After 20 years, one-third was dead, and of the survivors, 48% were on a methadone maintenance program. The authors concluded that heroin addiction is a chronic disease with a high fatality rate, and methadone maintenance offered a significant benefit.
8) Gronbladh L, Ohlund LS, Gunne LM, Mortality in heroin addiction: Impact of methadone treatment, Acta Psychiatrica Scandinavica Volume 82 (3) p. 223-227. Treatment of heroin addicts with methadone maintenance resulted in significantly fewer deaths, compared to untreated heroin addicts. Untreated addicts had a death rate 63 times expected for their age and gender; heroin addicts maintained on methadone had a death rate of 8 times expected, and most of that mortality was from diseases acquired prior to treatment with methadone. NIDA summarizes this in their findings and offers tables for easy assimilation of the data at https://www.drugabuse.gov/sites/default/files/pdf/partb.pdf.
9) Gunne and Gronbladh, 1981: The Swedish Methadone Maintenance Program: A Controlled Study, Drug and Alcohol Dependence, 1981; 7: p. 249 – 256. This 20 year study conducted a randomized controlled trial on opioid addicts either assigned to methadone maintenance with intensive vocational rehabilitation counseling, or to a control group that were referred to drug-free treatment. Over the 20 years, this study consistently showed significantly higher rates of subjects free from illicit opioids, higher rates of employment, and fewer deaths in the group maintained on methadone than for the control group.
10) Joseph, Herman, Sharon Stancliff, John Langrod. Methadone Maintenance Treatment (MMT): A Review of Historical and Clinical Issues. Mount Sinai Journal of Medicine, 2000; Vol 67, Nos 5&6: pp. 347-364. This is a review of Methadone efficacy in treating heroin addiction showing 50% higher treatment retention, and 50% fewer deaths. The article can be accessed at the following url:
11) Marsch LA. The efficacy of methadone maintenance in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis Addiction 1998; 93: pp. 515-532. This meta-analysis of studies of methadone concludes that methadone treatment reduces crime, reduces heroin use, and improves treatment retention.
12) Mattick RP, Breen C, Kimber J, et. al.,Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. The Cochrane Database of Systematic Reviews, 2003; (2): CD002209. This is a meta-analysis of studies of methadone treatment. The authors concluded that treatment of opioid dependence with methadone maintenance is significantly more effective than non-pharmacologic therapies. Patients on methadone maintenance are more likely to be retained in treatment and less likely to be using heroin.
13) Scherbaum N, Specka M, et.al., Does maintenance treatment reduce the mortality rate of opioid addicts? Fortschr Neurol Psychiatr, 2002, 70(9):455-461. Opioid addicts in continuous treatment with methadone had a much lower mortality rate (1.6% per year) than opioid addicts who left treatment (8.1% per year).
14) Sees KL, Delucchi KL, et.al. “Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence” Journal of the American Medical Association, 2000, 283:1303-1310. Compared the outcomes of opioid addicted patients randomized to methadone maintenance or to180-day detoxification using methadone, with extra psychosocial counseling. Results showed better outcomes in patients on maintenance. Patients on methadone maintenance showed greater retention in treatment and less heroin use than the patients on the 180 day taper.
15) Schottenfeld RS1, Pakes JR, Oliveto A, Ziedonis D, Kosten TR. Buprenorphine vs methadone maintenance treatment for concurrent opioid dependence and cocaine abuse. Archives of General Psychiatry 1997. 54(8):713-20. This article shows dose dependence for the success of both methadone and buprenorphine in MAT. The url is:
16) Strain EC, Bigelow GE, Liesbon IA, et. al. Moderate- vs high –dose methadone in the treatment of opioid dependence. A randomized trial. Journal of the American Medical Association 1999; 281: pp. 1000-1005. This study showed that methadone maintenance reduced illicit opioid use, and even better results with those in addition of psychosocial counseling. Methadone doses of 80mg to 100mg were more effective than doses of 50mg at reducing illicit opioid use and improving treatment retention.
17) Zanis D, Woody G; One-year mortality rates following methadone treatment discharge. Drug and Alcohol Dependence, 1998: vol.52 (3) 257-260. Five hundred and seven patients in a methadone maintenance program were followed for one year. In that time, 110 patients were discharged and were not in treatment anywhere. Of these patients, 8.2% were dead, mostly from heroin overdose. Of the patients retained in treatment, only 1% died.
Most heroin use begins with non-medical use of prescription opioids.
1) Jones, C. M. (2013). Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers—United States, 2002-2004 and 2008-2010. Drug and Alcohol Dependence, 2013: 1;132(1-2):95-100. Advance online publication. doi:10.1016/j.drugalcdep.2013.01.007
Heroin is more addictive than any other drug:
1) Nutt, David, Leslie A King, William Saulsbury, Colin Blakemore; Development of a rational scale to assess the harm of drugs of potential misuse.The Lancet, 2007: vol.369, No. 9566, p1047–1053. This scale was develpoed by Dr. David Nutt, Head of Neuropsychopharmacology and director of the Neuropsychopharmacology Unit in the Division of Brain Sciences at the Imperial College of London.
2) Henningfield Ratings and Benowitz Ratings defining addiction to include Reinforcement, Tolerance, Dependence and Intoxication.
1/4 of people use try heroin will become addicted
1) Institute of Medicine of the National Academy of Science report. In: Addiction: A Brain Ailment, Not a Moral Lapse, Brody, Jane E., N.Y. Times, Personal Health, 9-30-2003
2) National Institute on Drug Abuse. (2014). Drug Facts: Heroin. Bethesda, MD: National Institute on Drug Abuse. Available at http://www.drugabuse.gov/publications/drugfacts/heroin
There is between 91-97% relapse rate for heroin addicts who do not stay in treatment after detox.
1) Smyth, B P; Barry, J; Keenan, E; Ducray, K; Lapse and relapse following Inpatient treatment of opiate dependence. Irish Medical Journal, 2010: 103 (6):176-9. URL: http://www.lenus.ie/hse/handle/10147/110022. A study of 109 heroin addicts after initial detox. 94% had lapsed and 91% had relapsed most within first week.
2) the url: http://www.healthyplace.com. This site gives estimates of 97% relapse, but unclear where their studies are from).
There is between 60-87% relapse rate for heroin addicts even after treatment. These studies vary greatly.
1) eDrugrehab url http://www.edrugrehab.com/drugs-highest-rates-relapse. This site derives its information from SAMSHA, we have not yet verified its original source.
2) 1998 study by the Substance Abuse and Mental Health Service Administration (SAMHSA) found that relapse rate from heroin addiction is 87%. We have requested the article on this study.
3) the url: http://www.healthyplace.com. This site gives estimates of 97% relapse, but is not differentiated from those in treatment vs no treatment and do not differentiate between lapse and relapse.
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