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There is a broad range of treatment options for heroin addiction, including medications as well as behavioral therapies. Science has taught us that when medication treatment is integrated with other supportive services, patients are often able to stop heroin (or other opiate) use and return to more stable and productive lives.

In November 1997, the National Institutes of Health (NIH) convened a Consensus Panel on Effective Medical Treatment of Heroin Addiction. The panel of national experts concluded that opiate drug addictions are diseases of the brain and medical disorders that indeed can be treated effectively. The panel strongly recommended (1) broader access to methadone maintenance treatment programs for people who are addicted to heroin or other opiate drugs; and (2) the Federal and State regulations and other barriers impeding this access be eliminated. This panel also stressed the importance of providing substance abuse counseling, psychosocial therapies, and other supportive services to enhance retention and successful outcomes in methadone maintenance treatment programs. The panel’s full consensus statement is available by visiting the NIH Consensus Development Program Web site at consensus.nih.gov.

Methadone, a synthetic opiate medication that blocks the effects of heroin for about 24 hours, has a proven record of success when prescribed at a high enough dosage level for people addicted to heroin. Other approved medications are naloxone, which is used to treat cases of overdose, and naltrexone, both of which block the effects of morphine, heroin, and other opiates.

Buprenorphine is the most recent addition to the array of medications available for treating addiction to heroin and other opiates. This medication is different from methadone in that it offers less risk of addiction and can be dispensed in the privacy of a doctor’s office. Several other medications for use in heroin treatment programs are also under study.

For the pregnant heroin abuser, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse. There is preliminary evidence that buprenorphine also is safe and effective in treating heroin dependence during pregnancy, although infants exposed to methadone or buprenorphine during pregnancy typically require treatment for withdrawal symptoms. For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with relative safety, although the likelihood of relapse to heroin use should be considered.

There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. Several new behavioral therapies are showing particular promise for heroin addiction. Contingency management therapy uses a voucher-based system, where patients earn "points" based on negative drug tests, which they can exchange for items that encourage healthful living. Cognitive-behavioral interventions are designed to help modify the patient’s thinking, expectancies, and behaviors and to increase skills in coping with various life stressors.

An evaluation of alcoholism treatment suggests more ways to define success than strictly total abstinence. The method may help provide some changes to traditional approaches, the results of a case study suggest. "It may be argued that subjects who remain abstinent [from alcohol] during treatment are the most successful because psychosocial functioning and physical health depend on sobriety," say study authors Sue-Jane Wang, Ph.D., and Celia Winchell, M.D., and colleagues from the U.S. Food and Drug Administration in Rockville, Md. "However, other patterns of drinking are very common during treatment and many analytic approaches fail to make a distinction among the patterns." "For example, traditional research methods often don’t distinguish between a person who drinks only once a week during a 12-week trial and one who abstains for the first 10 weeks but spends the last two weeks intoxicated, according to the study.

These summary measures fail to capture the full complexity of the drinking pattern over time," the researchers say. The authors said, "There has been a great deal of contention on whether the effects of alcoholism treatment should be evaluated solely against the criterion of abstinence. The clinical community is still searching for a better description of what constitutes effectiveness in alcoholism treatment trials. More informative statistical analysis methods are necessary to arrive at meaningful evidence."

According to a Center for the Advancement of Health report, "Wang and colleagues tested a research tool called the ‘multiple failure time’ approach that asks more nuanced questions than traditional approaches, including: ‘Does the treatment reduce the rate of relapse to heavy drinking?’ They used this approach to re-examine a study that found weakly statistically significant evidence that an alcoholism treatment drug called naltrexone was effective." By taking into account both the time and the frequency of the study participants’ drinking episodes, the researchers noted two things that were overlooked in the first analysis: The risk of having any drinking episodes and any heavy drinking episodes was significantly lower in the group treated with naltrexone rather than a placebo, the report said. Source: The study results were published in the March 2003 journal Alcoholism: Clinical and Experimental Research.