26 April 2002
Most heroin users who want to quit should try methadone or buprenorphine first, with naltrexone a second option, according to Australian research, the world's first comparative study of its kind.
The study, which will be presented at the Royal Australasian College of Physicians conference in Brisbane next month, is the first randomised controlled trial to compare a drug that blocks the effects of heroin with a maintenance or substitution therapy.
For 90 per cent [of heroin users who want to quit], I would recommend agonists such as methadone or the partial opioid agonist buprenorphine as first-line treatment, with rapid detoxification with naltrexone a second-stage treatment,' said Brisbane researcher Professor John Saunders.
But the University of Queensland professor of alcohol and drug studies, and director of Royal Brisbane Hospital's alcohol and drug service, said it was important to offer people a range of options.
He said trial participants who stayed on naltrexone had excellent outcomes, with more than 90 per cent of people reducing their heroin use, which was better than those staying on methadone. But the naltrexone attrition rates (people stopping taking it) were significant.
Another reason why methadone should be tried first was because outcomes also depended on whether patients had previously been in treatment. Former methadone users who took naltrexone in the trial had retention rates of 50-60 per cent, compared with 20 per cent for people who had not tried methadone.
Last Reviewed: 26 April 2002