Pubdate: Tue, 13 Mar 2012
Source: Vancouver Sun (CN BC)
Copyright: 2012 The Vancouver Sun
Contact: http://www.canada.com/vancouversun/letters.html
Website: http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Randy Shore
Bookmark: www.mapinc.org/topic/NAOMI

HEROIN CHEAPER THAN METHADONE TO TREAT ADDICTION: STUDY

Addicts given the traditional maintenance drug were more likely to 
relapse and for longer, and cost the health, justice systems more

Using heroin to treat relapsed heroin users is more cost-effective 
than traditional methadone maintenance, according to a new study 
based on North America's only clinical trial of medically prescribed heroin.

A mathematical analysis using data from the North American Opiate 
Medication Initiative ( NAOMI) found that addicts prescribed heroin 
were less likely to relapse than those taking methadone and spent 
less time in relapse, which reduced their lifetime costs for health 
care and criminal justice and extended their lives.

The study by researchers from the University of B. C. and Providence 
Health Care was published Monday in the Canadian Medical Association Journal.

Addicts in methadone treatment generate an average lifetime cost to 
society of $ 1.14 million, compared to $ 1.09 million for an addict 
in heroin treatment, according to Aslam Anis, director of the Centre 
of Health Evaluation and Outcomes Sciences.

Most of the savings are realized when addicts are on maintenance and 
not involved with criminal behaviour, he said. The savings realized 
for male addicts are particularly profound.

Maintaining 2,000 male addicts between the ages of 26 and 35 on 
diacetylmorphine ( heroin) rather than methadone generates a net 
savings of $ 156,334,060 over their lifetime, according to the 
webbased NAOMI savings calculator developed by CHEOS. Maintaining 
2,000 females in the same age range generates $ 27,417,520 in savings.

The extra cost of heroin maintenance - $ 14,891 a year versus $ 3,192 
for methadone - is greatly outweighed by savings in medical and 
criminal justice expenses, Anis said.

More than 12,000 people were on methadone maintenance in British 
Columbia in 2010, according to the Centre for Addictions Research of 
B. C. Up to 25 per cent of addicts are considered resistant to 
methadone treatment.

The NAOMI study conducted in Vancouver and Montreal between 2005 and 
2008 recruited addicts who had already relapsed from methadone 
treatment at least twice.

Addicts in the study who were prescribed heroin rather than methadone 
were more likely to stay in treatment and more likely to quit heroin 
altogether than addicts on methadone maintenance. The findings were 
published in The New England Journal of Medicine.

The new study included extensive information gathered on NAOMI 
participants' use of the medical system to complete a complex 
mathematical extrapolation.

The health outcomes for addicts who stay on maintenance methadone and 
heroin are similar; the difference comes when addicts relapse. During 
the relapse period, addicts are more likely to be exposed to HIV and 
hepatitis and to engage in criminal activity, which adds to their 
lifetime medical treatment costs and shortens their lives, he explained.

"When they are in treatment it doesn't matter which medication they 
are getting," he said. "[ Those on maintenance] were committing very 
little crime and there was very little cost to the justice system 
from incarceration."

Most of the savings to be accrued by a heroin maintenance program 
would be in justice costs outside the silo of health care, making the 
extra burden to the health care system of more expensive treatment 
challenging for governments and policy-makers to justify.

"We don't have the resources to pay for everything we would like in 
the health care system, but interventions like this would save 
money," said Anis. "I think it's a no-brainer."

Former NAOMI participant Mark Fraser said the prescribed heroin 
program improved his health and freed him from the daily grind of 
chasing drug dealers. "It gave me so much time to take care of myself 
and to get work sorted out," he said. Fraser, 47, is employed in 
building maintenance on the city's Downtown Eastside.

Like many addicts, Fraser was forced to deal drugs on the side to 
support his habit. "When the NAOMI program ended, it forced me back 
into the criminality of using," said Fraser. "I was forced to do 
things I didn't want to do."

Fraser is now enrolled in the SALOME drug trial, which will attempt 
to transition heroin users to oral Dilaudid.
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MAP posted-by: Jay Bergstrom