Heroin addicts - Dihydrocodeine (DHC) as effective as methadone for treatment at half the cost ?

Heroin addicts, like the poor and the very rich are destined, it appears, to be always with us. Currently drug users are "treated" with methadone - about 20,000 people in Scotland are on methadone programmes. A liquid daily dose is medically prescribed which has to be consumed under supervision at the dispensing pharmacy (see pic) at an approximate cost of £1.500 per patient annually. Heroin releases an excess of dopamine in the body and causes users to need an opiate continuously occupying the opioid receptor in the brain. Methadone occupies this receptor and is the stabilizing factor that permits addicts on methadone to change their behavior and to discontinue heroin use.

Taken orally once a day, methadone, developed in war time Germany as a morphine replacement suppresses narcotic withdrawal for between 24 and 36 hours.

Methadone does not impair cognitive functions. It has no adverse effects on mental capability, intelligence, or employability. It is not sedating or intoxicating, nor does it interfere with ordinary activities such as driving a car or operating machinery. Patients are able to feel pain and experience emotional reactions. Vitally , methadone relieves the craving associated with opiate addiction. For methadone patients, typical street doses of heroin are ineffective at producing euphoria, making the use of heroin less desirable. In the US it is said treatment costs are approximately £2,400 per annum per patient.

Methadone treatment of heroin addicts was pioneered in the US in the 1960's by Dr. Vincent P. Dole, a specialist in metabolic diseases (he regarded obesity as an addiction to food) and Dr. Marie Nyswander, a Psychiatrist, who wrote a seminal book "The Drug Addict as a Patient" established the first heroin addiction programs in New York using methadone (read history of clinic here) - a romantic story - they later married.

Dihydrocodeine (DHC) is a valuable, easily sold medicine and requires no special handling or precautions. Used briefly as an anti-tussive (for coughs) and also longer term for pain relief it can over time be associated , as are many opiods with constipation.

Dihydrocodeine (DHC), a widely used opioid analgesic can be prescribed in tablet form, is easily and safely stored and costs for treating heroin addicts are £713 per patient per annum. In the United Kingdom dihydrocodeine is a Class B drug Illegal possession can result in up to 5 years in prison and/or an unlimited fine.In the USA, it is a DEA Schedule II substance the same as cocaine, although very low doses may be classified as Schedule III.

Link for experience of regular users for intensive pain relief here

Edinburgh GP, Dr Roy Robertson ( and a Reader at the University of Edinburgh) in a study funded by Chief Scientist Office recruited 235 subjects (168 male, 67 female) with opiate dependence syndrome for study over 42 months. He and his colleagues found that the prescription painkiller dihydrocodeine is equally as effective as methadone to help drug users kick the habit (No figures are available). Its effectiveness has never been tested before (!), even though it has been used for many years - because it is not as toxic and less likely to cause a fatal overdose and often in prisons or police custody. Report in Addiction and Abstract (see Footnote)

Indirect comparisons with other studies are said to show dihydrocodeine (and methadone) to be superior to the use of placebos.

Dr Robertson says "Methadone should still be used to treat the majority of patients withdrawing from heroin and requiring maintenance treatment, but dihydrocodeine offers an alternative treatment for those who can’t tolerate methadone, or find it hard to deal with the stigma of having to take their dose –sometimes every day –in a pharmacy. It is also much cheaper."

"We want to engage young people in a treatment programme which stops them from injecting drugs and running the risk of infection," he said.

"Apart from the danger of contracting AIDS, drug users run the real risk of exposure to the potentially fatal liver disease, Hepatitis C. We face an epidemic of Hepatitis C in Scotland, with 40% of young people who have been injecting drugs for more than two years being infected with this serious illness."

One is left in confusion, are we treating drug addicts or trying to prevent them spreading disease by dirty needles ? ..or both ...or even neither.

This is what Cyswllt Ceredigion Contact who were nominated the "National Drug Team of the Year 2006" say on their website

It is our experience - as ex-drug addicts and addiction counsellors - that methadone is as dangerous and as harmful as is heroin. While methadone maintenance does represent a low-cost form of treatment for opiate addicts (and this may be its main attraction), it offers little or no incentive for an addict to stop taking drugs.

....but turn to the Drink and Drugs Net newsletter May 2006 and the claims that ..

‘The evidence is overwhelming that methadone treatment, if delivered properly, reduces infections and death, improves health and social functioning, and is also the most effective route to eventual abstinence. ‘

Confused ? You will be.

Footnote - The full citation of the Article in Addiction is ;
Volume 101 Issue 12 Page 1752 - December 2006
Addiction 101 (12), 1752–1759.
doi:10.1111/j.1360-0443.2006.01603.x
Addressing the efficacy of dihydrocodeine versus methadone as an alternative maintenance treatment for opiate dependence: a randomized controlled trial
* J. Roy Robertson11Division of Community Health Sciences, University of Edinburgh, Edinburgh, J. Roy Robertson, Muirhouse Medical Group, 1 Muirhouse Avenue, Edinburgh EH4 4PL, UK. E-mail: roy.robertson@ed.ac.uk ,
* Gillian M. Raab32Community Drug Problems Service, Edinburgh, ,
* Malcolm Bruce23School of Community Health, Napier University, Edinburgh, UK and ,
* James S. McKenzie23School of Community Health, Napier University, Edinburgh, UK and ,
* Helen R. Storkey32Community Drug Problems Service, Edinburgh, &
* Amy Salter44School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia