Aug. 19 (Bloomberg) -- People prescribed heroin to treat opioid addiction are more able than those given methadone to stay in recovery programs and are less likely to pursue illicit drugs or other illegal activities, a study found.

Almost 90 percent of the addicts who were assigned to the heroin group remained in treatment in a follow-up analysis a year later, compared with 54 percent in the methadone group, according to a study in the New England Journal of Medicine. The heroin-treated addicts’ spending on illicit drugs dropped to $320 a month, compared with $400 in the methadone group, from the $1,200 a month they spent on drugs before treatment.

About 15 to 25 percent of opioid addicts don’t have a good response to methadone, the most common treatment for heroin addiction, according to background information in the paper. European studies have suggested that prescribing pharmaceutical heroin may help those patients most resistant to treatment.

“The whole idea is that if you get them into this clinic, and they sit there a couple times a day and are in contact with health-care providers, it’s more likely they’ll have benefits,” said study author Martin Schechter of the University of British Columbia’s School of Population and Public Health. “The longer you can keep someone in treatment, the better.”

Less Convenient

Heroin, as prescribed in the study, was less convenient than the pill methadone. It was injected three times a day by health-care workers, Schecter said. The maximum allowed dose was 1,000 milligrams a day, and the average dose was less than half of that. The dosage didn’t increase over time, Schecter said.

Opioids are chemicals that bind to certain receptors in the brain, and include drugs such as morphine, codeine, hydrocodone, oxycodone, heroin and the painkiller fentanyl. Other treatments for opioid addiction include buprenorphine and naltrexone, according to the National Institute on Drug Abuse.

All participants in the study had failed at least two previous attempts at treatment, the research article said. At least one of those treatment efforts used methadone.

Of 115 people prescribed heroin, 101 remained in treatment after one year. Of the 111 participants given methadone, 60 were still in treatment at that time.

The most common side-effects related to treatment with heroin were overdoses and seizures, and 16 of the 115 patients assigned to heroin experienced life-threatening events from these problems, the study said. All the patients recovered, since they were closely monitored by health-care staff.

Illicit Use Dropped

The number of days the addicts illicitly used heroin dropped to five a month from 27 a month in the heroin-treated group, according to the study. The days the methadone group used heroin dropped to 12 from 27 a month.

The two groups showed no difference in their additional illicit use of cocaine. Heroin users sometimes use cocaine and heroin together, in a concoction known as a speedball. A speedball-induced overdose killed comedian John Belushi in 1982 at the age of 33.

Heroin treatment was more expensive than that for methadone. It’s still cheaper than unchecked addiction, Schechter said. An untreated heroin addict in Canada is estimated to cost about $50,000 a year, from use of the medical and criminal justice systems. Medicinal heroin costs about $5,000 to $10,000 a year, Schechter said.

Restricted Use

The U.K.’s National Treatment Agency for Substance Misuse recommends that injectable heroin be considered only for the minority of patients who aren’t helped by oral methadone. Switzerland and the Netherlands allow prescription heroin for addicts, according to the editorial accompanying the study. Germany and Spain don’t authorize the use, wrote Virginia Berridge, a professor at the London School of Hygiene and Tropical Medicine and the author of the editorial. The U.S. banned the drug in 1924, when Congress passed the Heroin Act.

Heroin was first synthesized in 1874 and sold by Bayer AG. It was meant to be a safer painkiller than morphine, as well as a more effective cough remedy than codeine. The drug was praised in the early 1900s for its effectiveness by doctors in the Boston Medical and Surgical Journal, the New York Medical Journal and the Journal of the American Medical Association, and the Canadian Journal of Medicine and Surgery.

Bayer stopped making the drug in 1913, as heroin addiction began to swell. Heroin, the most abused of the opiates, is currently considered a schedule I substance, meaning it has a high potential for abuse and no accepted medical use, according to the U.S. Department of Justice.

HIV Infection Risk

Because heroin is often injected with a needle, its illicit use increases the risk of spreading infection with HIV among users, according to the Drug Enforcement Agency. The drug initially gives the user a feeling of euphoria. Long-term use leads to collapsed veins, infections of the heart and liver disease, as well as an increased risk of pneumonia. Withdrawal from the drug produces restlessness, pain, insomnia, vomiting, and occasionally death.

The study also included 25 patients taking hydromorphone, marketed by Abbott Laboratories as Dilaudid. The drug, approved by the FDA to treat severe pain in cancer, surgery, trauma and cardiac victims, appeared to work as well as heroin, though there weren’t enough patients in the sample to achieve statistically significant results. Future studies may examine Dilaudid for treatment abuse, Schechter said.

“I don’t think Dilaudid would be as unacceptable as heroin to most people in the U.S.,” he said.

To contact the reporter on this story: Elizabeth Lopatto in New York at elopatto@bloomberg.net.

Last Updated: August 19, 2009 17:00 EDT