Pierre Lauzon

Diacetylmorphine versus Methadone for the Treatment of Opioid Addiction

BACKGROUND Studies in Europe have suggested that injectable diacetylmorphine, the active ingredient in heroin, can be an effective adjunctive treatment for chronic, relapsing opioid dependence. METHODS In an open-label, phase 3, randomized, controlled trial in Canada, we compared injectable diacetylmorphine with oral methadone maintenance therapy in patients with opioid dependence that was refractory to treatment. Long-term users of injectable heroin who had not benefited from at least two previous attempts at treatment for addiction (including at least one methadone treatment) were randomly assigned to receive methadone (111 patients) or diacetylmorphine (115 patients). The primary outcomes, assessed at 12 months, were retention in addiction treatment or drug-free status and a reduction in illicit-drug use or other illegal activity according to the European Addiction Severity Index. RESULTS The primary outcomes were determined in 95.2% of the participants. On the basis of an intention-to-treat analysis, the rate of retention in addiction treatment in the diacetylmorphine group was 87.8%, as compared with 54.1% in the methadone group (rate ratio for retention, 1.62; 95% confidence interval [CI], 1.35 to 1.95; P<0.001). The reduction in rates of illicit-drug use or other illegal activity was 67.0% in the diacetylmorphine group and 47.7% in the methadone group (rate ratio, 1.40; 95% CI, 1.11 to 1.77; P=0.004). The most common serious adverse events associated with diacetylmorphine injections were overdoses (in 10 patients) and seizures (in 6 patients). CONCLUSIONS Injectable diacetylmorphine was more effective than oral methadone. Because of a risk of overdoses and seizures, diacetylmorphine maintenance therapy should be delivered in settings where prompt medical intervention is available. (ClinicalTrials.gov number, NCT00175357.)

Illicit Use of Methadone Among IV Drug Users in Montreal

Few studies have been done on the prevalence of illicit methadone use. Five hundred fifty-nine IV drug users recruited in various ways in Montreal were interviewed concerning their drug use as part of a longitudinal study on HIV infection. Of this number, 133 had heroin as their drug of preference and 426 cocaine. Among the cocaine group, 202 also used heroin. The lifetime prevalence of any illicit methadone use was 59.4% in the heroin group, 26.7% in the cocaine/heroin group, and 3.6% in the cocaine-only group. The 6-month (preceding the interview) prevalence of any illicit use was 42.1%, 6.9%, and 1.3%, respectively, and the prevalence of at least weekly illicit use during that period was 6.3%, 2.0%, and 0%, respectively. The prevalence of illicit methadone use is significant in the population studied. Whether this level of use will be affected by more stringent control on methadone prescription and dispensation remains to be demonstrated.

Methadone maintenance: Predictors of outcome in a Canadian milieu

This hypothesis-generating study attempts to identify patient characteristics predicting the successful outcome of methadone maintenance in the treatment of narcotic addiction. The sociodemographic characteristics as well as the general emotional health of 51 addicted individuals in Montreal were studied at entry into the program and are correlated with success one year after entry. The success of the Montreal program, defined as retention in the program and urine samples negative for opiates, is comparable to results reported from many North American clinics. A history of foster care before age 15 is the only characteristic significantly correlated with both retention and negative urines. Emotional health, previous treatment experiences, job status, and level of education do not correlate with success. All addicted individuals applying to a treatment program should therefore be accepted for a trial of treatment while further research on greater numbers of subjects may eventually identify predictors of successful outcome.

Two cases of clonidine abuse/dependence in methadone-maintained patients

Clonidine has been used to assist opiate detoxification in the past 10 years. This substance is known to have multiple effects on the central nervous system and to cause withdrawal symptoms when stopped abruptly. The combination of these two effects could result in clonidine having a potential for abuse. Two cases of clonidine abuse/dependence in methadone-maintained patients are presented. Nonmedical use of clonidine in opioid-dependent persons has never been evaluated.

Psychological Predictors of Retention in a Low-Threshold Methadone Maintenance Treatment for Opioid Addicts: A 1-Year Follow-Up Study

This study investigated the role of psychological variables and judicial problems in treatment retention for a low-threshold methadone program in Montreal, Canada. Logistic regression analyses were computed to examine associations between psychological variables (psychological distress, self-esteem, stages of change), criminal justice involvement, and treatment retention for 106 highly-disorganized opioid users. Higher methadone dosage was associated with increased odds of treatment retention, whereas criminal charges and lower self-esteem decreased these odds. Psychological variables could be identified early in treatment and targeted to increase potential treatment retention. Financial support for this study was provided by the Fonds de Recherche en Santé du Québec.