Using injectable diacetylmorphine to treat chronic, refractory opioid dependence may be more effective and economical compared with methadone maintenance, according to data published in CMAJ.
Researchers from British Columbia and Quebec suggest that diacetylmorphine, an active ingredient in heroin, is more effective than methadone in keeping opioid-dependent people in treatment. Although direct treatment costs for diacetylmorphine can be up to 10 times greater than methadone, they said patients who receive methadone treatment are unable to abstain from illicit drug use for extended periods.
“Our model indicated that diacetylmorphine would decrease societal costs, largely by reducing costs associated with crime,” Aslam Anis, PhD, researcher and director of the Centre for Health Evaluation and Outcome Sciences, and professor at the University of British Columbia’s School of Population and Public Health, and colleagues wrote. “It would increase both the duration and quality of life of treatment recipients.”
Using data from the North American Opiate Medication Initiative, which was a randomized controlled trial conducted in two Canadian cities, researchers extrapolated that over a lifetime horizon participants in the methadone program would live 14.54 years on average upon entering the model. They would be in treatment for 8.79 years and spend 5.52 years in relapse at an estimated societal cost of $1.14 million Canadian dollars.
Conversely, a person undergoing treatment with diacetylmorphine would live 15.45 years with 10.41 years in treatment and 4.05 years in relapse at a cost of $1.10 million Canadian dollars.
“We found that diacetylmorphine may be more effective and less costly than methadone among people with chronic opioid dependence refractory to treatment,” the researchers concluded.
Disclosures: Dr. Anis and associates report receiving grants for the North American Opiate Medication Initiative from the Canadian Institutes of Health Research, the Canada Foundation for Innovation, the Canada Research Chairs Program, the University of British Columbia, Providence Health Care, Université de Montréal, Centre de recherche et d’aide pour narcomanes, the Government of Quebec, Vancouver Coastal Health and the BC Centre for Disease Control. Two of the authors, Suzanne Brissette, MD, and David C. Marsh, MD, report receiving payments from Schering-Plough.