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National Institute on Drug Abuse -  NIDA NOTES
Director's Column
Volume 12, Number 6
November/December 1997

Applying Scientific Research Can Counter Rise in Heroin Use

NIDA Director Dr. Alan I. Leshner

NIDA Director, Alan I. Leshner

NIDA research has given us a variety of tools that we can use to treat heroin addiction and address this public health challenge.

For More Information

The NIDA research report, Heroin Abuse and Addiction (NCADI publication #PHD742), can be obtained from from NIDA DrugPubs

The NIH consensus development conference statement on Effective Medical Treatment of Heroin Addiction is available by calling 1-888-644-2667.

The statement can also be downloaded from the NIH Consensus Development Program World Wide Web site at

NIDA has launched what we hope will be a successful preemptive strike using the full power of science to stop a troubling spread of heroin use among our Nation's youth. The strike began in full force at NIDA's National Conference on Heroin Use and Addiction this past September, building on many activities that long have been under way.

During the past 5 years, NIDA's early drug abuse warning systems and a number of national surveys have shown that younger and wider segments of the population are abusing heroin. Most of the estimated 141,000 new heroin users in 1995 were under the age of 26, according to the National Household Study on Drug Abuse. And, from 1991 to 1996, the percentage of the Nation's 8th, 10th, and 12th graders who used heroin in the past year rose substantially, according to NIDA's 1997 Monitoring the Future study. The good news is that heroin use remained stable in 1997, the study indicates.

New drug trafficking patterns, increased purity, and decreased price may all have contributed to this increasing trend in heroin use. Our research also indicates that a change in the way heroin is used may have attracted a new population of young users. Some of these young users are snorting and sniffing the drug and wrongly believe that if they don't inject heroin they won't become addicted to it. However, repeated use of heroin by any method induces neurobiological changes that trap the user in a downward spiral of addiction. The consequences of this addiction can include violence and criminal acts, HIV/AIDS, hepatitis, tuberculosis, and even death from overdose or medical complications.

Fortunately, NIDA-funded research has given us many means to address this problem. Our research has yielded a tremendous amount of knowledge about the true nature of addiction as a chronic brain disease that results from prolonged drug use. Most importantly, this research also has given us a variety of tools that we can use to treat heroin addiction and address this public health challenge. This research also has developed effective prevention programs that can reduce the risk of heroin use among children.

The most important task in drug abuse treatment is to match the treatment approach to the individual needs of the patient. Behavioral and pharmacological treatments each help restore a degree of normalcy to brain function and behavior that have been disrupted during the addiction process. Ultimately, however, integrating both types of treatment will provide the most effective approach.

Effective research-based behavioral treatment approaches for heroin addiction include long-term treatment in residential therapeutic communities and outpatient treatment programs. Over the years, NIDA has developed a broad array of effective interventions that can be used in these treatment settings. Cognitive-behavioral interventions modify patients' thinking and behaviors and increase their coping skills to enable them to deal with difficult situations without resorting to drugs. Contingency management therapy uses a voucher-based system where patients earn "points" based on negative drug tests, which they can exchange for items that encourage healthy living.

Because behavioral treatments are so important in countering heroin and other drug abuse, developing new behavioral treatments and speeding their way into clinical practice are major goals of NIDA's Treatment Initiative. The Initiative, which is working to improve the quality of the Nation's drug abuse treatment, will showcase effective behavioral treatments at NIDA's National Conference on Drug Addiction Treatment Research. The conference will be held in Washington, D.C., on April 8 and 9, 1998. (See "NIDA Launches Drug Abuse Treatment Initiative," NIDA NOTES, July/August 1997.)

As I noted above, it is when behavioral therapies are integrated with pharmacological treatments that we get the best heroin treatment results. Pharmacological treatments include the most widely used medication for heroin addiction, methadone, and LAAM (leva-alpha-acetyl-methadol), a newer medication developed by NIDA as an alternative to methadone. Both medications reduce drug use, normalize brain and physiological functions disrupted by heroin addiction, reduce mortality and disease associated with drug abuse, and enable heroin-addicted patients to live productive lives.

To provide practitioners with additional options for treating heroin addiction, NIDA's Medications Development Division (MDD) continues to work on new compounds. For example, one promising heroin treatment medication, buprenorphine, may become the first-line therapy for the newly addicted patient. Data from clinical trials suggest buprenorphine is very safe and has few side effects or withdrawal symptoms. As additional heroin treatment medications become available, we will be better able to vary medications and doses to meet the individual needs of patients at different stages of treatment.

A critical component of NIDA's preemptive strike is disseminating the scientific knowledge and the drug abuse prevention and treatment tools we have developed to people working to address the problem in the community. For example, NIDA held a national research-based conference on heroin use and addiction in September in Washington, D.C. At the conference, more than 600 scientists, practitioners, policymakers, representatives of constituency groups, and criminal justice personnel from around the Nation shared information about changing trends in heroin use, the devastating costs of heroin addiction, and how communities can prevent and treat heroin abuse. (See "NIDA Conference Aims 'Preemptive Strike' at Increased Heroin Use Among Nation's Young People")

To address barriers to the clinical use of effective treatments for heroin addiction, NIDA, the National Institutes of Health (NIH) Office of Medical Applications of Research, and the NIH Office of Research on Women's Health cosponsored an NIH Consensus Development Conference on Effective Medical Treatment of Heroin Addiction in November in Bethesda, Maryland. Following a thorough review of the accumulated evidence, an independent panel of nongovernment experts concluded that methadone treatment significantly lowers heroin and other illicit opiate drug use, reduces opiate-related illness and death, reduces crime, and enhances social productivity. The panel strongly recommended broader access to methadone treatment programs for people who are addicted to heroin and other opiate drugs. (See "NIH Panel Calls for Expanded Methadone Treatment for Heroin Addiction")

Finally, to arm the general public, policymakers, health care practitioners, and prevention and treatment service providers with the scientific facts about heroin, NIDA has developed a new research report, Heroin Abuse and Addiction, which provides an overview of the latest research findings on heroin.

The signs of increased heroin use we have seen, especially among the young, are a warning signal to the drug abuse research, prevention, and treatment communities. NIDA has heeded that warning. By intensifying our drug abuse treatment research and increasing our dissemination of the research-based facts about heroin abuse and addiction, NIDA is providing the knowledge and tools that practitioners and communities can use to prevent heroin use and treat the destructive disease of heroin addiction.

NIDA NOTES - November/December 1997

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