Medically prescribed heroin is more cost-effective than methadone for treating long-term street heroin users, according to a new study by researchers at Providence Health Care and the University of British Columbia.
The study, published today in the Canadian Medical Association Journal (CMAJ), attributed most of the economic benefits to the fact that recipients of medically prescribed heroin (diacetylmorphine) stayed in treatment longer and spent less time in relapse than those receiving methadone. Both results are associated with reduced criminal activity and lower health care costs.
Additionally, an individual in the diacetylmorphine group was more likely to live longer than someone receiving methadone maintenance therapy.
The findings were drawn from the North American Opiate Medication Initiative (NAOMI), a trial of medically prescribed heroin that took place in Vancouver from 2005 to 2008, as well as administrative drug data from British Columbia. NAOMI was North America's first-ever clinical trial of prescribed heroin.
The researchers – led by Dr. Aslam Anis, director of the Centre for Health Evaluation and Outcome Sciences (CHÉOS) at Providence Health Care and professor in UBC's School of Population and Public Health – used a cost-effectiveness analysis to compare treatments over a one-, five- and 10-year period, as well as a lifetime horizon.
Those in the methadone therapy group generated an average lifetime societal cost of $1.14 million per person, while those in the diacetylmorphine group generated a lesser cost of $1.09 million. The study considered treatment expenditures, estimated costs for drug therapies and costs borne by the justice system.
"NAOMI demonstrated that heroin-assisted therapy is a more effective treatment option than MMT, but now, thanks to this study, we can also confidently say that there are significant economic benefits of using this medication," Dr. Anis says.
"The question I get most about heroin-assisted therapy is whether we can afford the increased direct costs of the treatment," says co-author Dr. Martin Schechter, a CHÉOS scientist and professor at UBC's School of Population and Public Health. "What this study shows is that the more appropriate question is whether we can afford not to."
The NAOMI study, which was also led by researchers from PHC, CHÉOS and UBC, was a randomized trial aimed at testing whether medically prescribed heroin was more effective than methadone therapy for individuals who were not currently benefiting from conventional treatment.
The results, published in the New England Journal of Medicine, showed that patients treated with the prescribed heroin were more likely to stay in treatment or quit heroin altogether and more likely to reduce their use of illegal drugs and other illegal activities than patients treated with oral methadone.
The study is a collaboration with CHÉOS, UBC, Université de Montréal and the Northern Ontario School of Medicine.
About the Centre for Health Evaluation and Outcome Sciences (CHÉOS) A centre of the Providence Health Care Research Institute, the Centre for Health Evaluation and Outcome Sciences (CHÉOS) is an inter-disciplinary research collective founded to pursue excellence through the evaluation, interpretation and communication of health outcomes research. CHÉOS works across all of PHC Research Institute's health disciplines, including aging, cardiopulmonary health, urban health, HIV/AIDS, mental health, and kidney health.
About Providence Health Care
Providence Health Care is one of Canada's largest faith-based health care organizations, operating 15 facilities within Vancouver Coastal Health. Guided by the principle, "How you want to be treated," PHC's 1,200 physicians, 6,000 staff and 1,500 volunteers deliver compassionate care to patients and residents in British Columbia. Providence's programs and services span the complete continuum of care and serve people throughout B.C. PHC operates one of two adult academic health science centres in the province, performs cutting-edge research in more than 30 clinical specialties, and focuses its services on six "populations of emphasis": cardiopulmonary risks and illnesses, HIV/AIDS, mental health, renal risks and illness, specialized needs in aging and urban health.
About the University of British Columbia
The University of British Columbia (UBC) is one of North America's largest public research and teaching institutions, and one of only two Canadian institutions consistently ranked among the world's 40 best universities. Surrounded by the beauty of the Canadian West, it is a place that inspires bold, new ways of thinking that have helped make it a national leader in areas as diverse as community service learning, sustainability and research commercialization. UBC offers more than 50,000 students a range of innovative programs and attracts $550 million per year in research funding from government, non-profit organizations and industry through 7,000 grants.
Journal
Canadian Medical Association Journal