Getting Heroin Junkies on the LAAM

Heroin addicts can cut their drug use up to 90% with a medication more convenient than the standard treatment, according to a report in tomorrow's Journal of the American Medical Association. The researchers hope that the finding will encourage more clinics to try the treatment--it halves the number of visits needed--and speed up approval of the drug, which has languished in many state regulatory agencies.

For more than 2 decades, people addicted to opioid drugs such as heroin have been treated with methadone, which binds to receptors in the brain that are stimulated by opioids, but doesn't give the high. However, many patients received doses that were too small and have relapsed, says George Bigelow, a psychologist at Johns Hopkins University. When another compound, called levomethadyl acetate or LAAM, was approved by the FDA in 1993, Bigelow and colleagues decided to see if higher doses of LAAM might prevent the recidivism seen with methadone.

The team enrolled 180 addicts who came to their clinic seeking treatment. A third were given 25-milligram doses of LAAM, another third 50 mg, and the others 100 mg; neither doctors nor patients knew the strength of the pills. Within a week, patients receiving the highest doses had dramatically cut back on drug use. By the end of the 17-week trial, the patients had reported a 90% drop, from 29 days per month to 2.5 days. Those on the lowest doses cut back to 6 days a month. Both reports were confirmed with urine tests.

Because LAAM needs to be taken only three times a week, rather than every day like methadone, it makes treatment more convenient, upping the chances that addicts will stick to a treatment regimen. Bigelow also hopes that more states will approve LAAM and loosen its regulation; currently it, like methadone, is only available in specially licensed addiction clinics, mainly because of fears that addicts might sell the drug. "There is no other medical condition for which such wonderfully effective drugs are so hard to get," he says.

Other experts also hope to see LAAM find its way into more clinics. "This kind of study is important for reinforcing the need to give the maximum effective dose," says Alan Lesher, head of the National Institute on Drug Abuse, which funded the study. "Once you do, the payoff is tremendous."