Diacetylmorphine for opioid addiction cheaper and more effective than methadone

Using injectable diacetylmorphine — the active ingredient in heroin — to treat chronic opioid addiction is cheaper and more effective than methadone, states an article in CMAJ (Canadian Medical Association Journal).

Methadone is the most common treatment for people who are dependent on opioids such as heroin, although research indicates that most people over time go back to using illicit drugs. The North American Opiate Medication Initiative, a randomized controlled trial, indicated that diacetylmorphine is more effective in keeping opioid-dependent people in treatment. However, the cost of the treatment is higher than methadone.

Researchers from the Centre for Health Evaluation and Outcome Sciences (CHEOS) at Providence Health Care, University of British Columbia, Université de Montréal and the Northern Ontario School of Medicine (Sudbury, Ont.) used a model to estimate costs for both treatment options based on outcomes from the North American Opiate Medication Initiative, taking into account possibilities of HIV infection, periods of treatment, abstinence and relapse.

They found that using diacetylmorphine in opioid-dependent people was cheaper than using methadone. A person in a methadone program would live 14.54 years after entering the model, with 8.79 years in treatment and 5.52 years in relapse, with an estimated cost to society of $1 137 614 in present dollars. Someone with access to diacetylmorphine treatment would live 15.45 years, 10.41 years in treatment and 4.05 years in relapse for a cost of $1 096 053 to society.

"Our model indicated that diacetylmorphine would decrease societal costs, largely by reducing costs associated with crime, and would increase both the duration and quality of life of treatment recipients," writes Dr. Aslam Anis, director of CHEOS at Providence Health Care and professor at UBC's School of Population and Public Health with coauthors. "Because opioid users commit less crime and have lower rates of health care use and death while in treatment, the benefits in cost and health utility attributable to diacetylmorphine stemmed chiefly from its capacity to retain patients in treatment for longer periods than with methadone maintenance treatment."

The authors conclude that a diacetylmorphine treatment strategy could reduce costs in treating chronic opioid addiction.