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There can be few battlefields more fraught than the one over treatments for heroin dependence. The people advocating heroin-prescribing trials often reckon none are worth much cop; we had an Israeli advocating naltrexone a few years ago and championed by a woman's magazine and commercial television and methadone gets slagged from time to time. A national trial has been conducted to sort out fact from fiction, comparing methadone, naltrexone, a drug called buprenorphine and LAM, a long acting opiate. If you've had nothing to do with heroin then you could be forgiven for assuming that success in a trial like this is being off all drugs after a period of time. Unfortunately it doesn't work that way. Heroin dependence is a chronic relapsing condition that kills one third of people over 20 years of use. So researchers are more realistic. They were looking for people still in treatment after 6 months and who'd significantly reduced their heroin intake - which in turn usually translates to better health and less crime. Naltrexone was the worst performer with only 8 people out of 300 still on it after six months. The rest had switched to something else or returned to heroin. Methadone and buprenorphine came off best with nearly a half being still on treatment. Buprenorphine was more expensive but associated with a greater feeling of normalisation. So... the message is, don't believe everything you read in women's magazines.
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