When receiving maintenance treatment, heroine addicts take increasingly smaller doses of a synthetic or partially-synthetic opiate, usually either methadone and buprenorphine. These drugs do not deliver the high brought on by heroin use, but they do prevent withdrawal symptoms from occurring, and this allows addicts to gradually stop their use of the drug. While effective, maintenance treatment is often highly regulated and is even illegal in some areas, especially in addiction clinics outside of the United States. However, this form of treatment may be a crucial element of recovery for many individuals, as research from the June issue of the Lancet illustrates.

A team of researchers from the Yale University School of Medicine collaborated with researchers from Malaysia, studying 126 Malaysian individuals addicted to heroin. While all subjects received drug counseling, 44 were given concurrent maintenance therapy with buprenorphine while 43 were given a course of naltrexone, a non-opiate drug designed to block opiate receptors. The final 39 subjects received a placebo. The researchers used urine tests to measure the subjects’ drug status several times each week. After 24 weeks of treatment, subjects taking a placebo had the worst outcomes, while those taking buprenorphine had they best outcomes. They were better able to adhere to the treatment and were more likely to complete the study without relapsing, which was defined as three positive drug tests. Those who did relapse went a longer period of time before returning to drug use and lasted over twice as long as the other subjects before experiencing a full relapse. They also achieved more consecutive days of abstinence than subjects in either of the other two groups.

Despite these promising findings, maintenance treatment is not a perfect solution for heroin addicts, as both methadone and buprenorphine have powerful side effects and withdrawal symptoms. Although used in treatment, these drugs can still be sold on the streets, and many countries, including Malaysia, have banned both drugs because of these and other concerns. In summarizing their results, the Yale researchers stress that the advantages provided by maintenance treatment outweigh its problems, and future studies should focus on this subject to further show the effectiveness of maintenance treatment in combination with counseling. Overcoming addiction is a challenging prospect, but if maintenance treatment becomes more widely available, a greater number of heroin addicts all over the world may achieve a successful recovery.