Is Hydromorphone a Viable Option for Heroin Addiction Treatment?

Heroin addiction is notoriously difficult to overcome, and a heavy focus in addiction treatment research is dedicated to finding new treatment options to help people stop using heroin safely and avoid relapse for the long-term.

One recent study published in the journal JAMA Psychiatry suggests that, in addition to Suboxone, methadone, and Vivitrol, the painkiller hydromorphone may also be effective in helping people to overcome heroin addiction.

Also known by the brand name Dilaudid, the drug was given as an injection to one group of study participants while the other group received diacetylmorphine injections, otherwise known as pharmaceutical-grade heroin, according to HealthDay. About 80 percent of participants remained in treatment for the six-month duration of the study, and of these, a significant decrease in crimes and street drug use was noted by both groups.

Eugenia Oviedo-Joekes of the University of British Columbia was lead investigator on the study. In a news release, she said: “Hydromorphone is a widely available licensed pain medication. Our study shows that hydromorphone is as effective as diacetylmorphine, providing a licensed alternative to treat severe opioid use disorder.”

The good news is that the study may have identified another viable maintenance option for people who are unable to avoid relapse in heroin addiction recovery. But many people question whether or not maintenance medications of any kind are the best choice for those who are seeking to create new lives for themselves that are not defined by drug use or dependence of any kind.

Other Options in Treatment

Many people are turned off by the idea of essentially trading one addiction for another. They see stopping the use of heroin only to start using another opiate drug to be self-defeating and believe that the person who chooses this path is continuing to live in the haze of drug use and constantly at risk – high risk – of relapse.

The people in the anti-maintenance medication camp propose that the better choice is to quit “cold turkey” and take advantage of the many therapies – traditional, alternative, and holistic – that can help the individual to stabilize in recovery and learn coping mechanisms that will help to mitigate cravings and avoid relapse naturally without the use of addictive medications. Their opinion is that with enough focus and persistence, there is no need to take the risk of ongoing opiate drug use, and that the person will, as a result, enjoy a much higher quality of life and freedom.

Unique Path to Recovery

While it is true that the use of opiate medications means ongoing use of an addictive drug and that this choice does create a life experience that is different from a life that is lived without use of any mind-altering substances, it is not necessarily an option for all who seek to overcome addiction to quit “cold turkey.” For those who have lived with an opiate addiction for decades, who struggle with homelessness and mental health issues, and who have tried every method of treatment yet cannot find the balance in recovery that will help them to avoid relapse, it may not be an option to live without maintenance medication of some kind.

However, for others who have been abusing opiate drugs for a short time or who otherwise feel more stable in recovery and therefore better equipped to manage independent living in recovery without medication, a combination of therapeutic interventions after detox may be the better choice.

And for many others, it may be that use of medication maintenance for a time – six months, a year, a few years – followed by slowly tapering off the drug at a measured pace is the best option. This allows each individual to create a treatment plan that is appropriate to their personal needs, without judgment or expectation, that eventually leads to stability in recovery with or without continued use of medication.

Whether or not the use of maintenance medications is the best choice is a question that must be answered on an individual basis in consultation with medical and substance abuse treatment professionals. In some cases, it may be appropriate to adjust and change direction in opiate addiction treatment in terms of the type of medication used and the dosage.

Dr. Patricia Daly is the Chief Medical Officer at Vancouver Coastal Health. She points out that while hydromorphone may be an effective treatment for some, so too are methadone and buprenorphine. She says: “No single treatment is effective for all individuals. Every person with severe opioid use disorder left untreated is at high risk of serious illness and premature death.”

Increasing Access to Maintenance Medications

In the past, one of the biggest problems facing those who would benefit from use of maintenance medications is lack of access. High cost and limitations placed on the dispensation of these drugs don’t necessarily make it easy for people in need of treatment to connect with the services that will help them heal.

President Obama has been making an effort to increase the funds made available to state governments for the purposes of purchasing maintenance medications for people in need. Additionally, he is proposing to increase the limitation on the number of patients allowed per doctor in regard to those who can prescribe buprenorphine, an office-based medication that does not require in-person daily dispensation as methadone does.

What Do You Think?

Is medication maintenance a positive choice for people working to overcome heroin addiction? Or do you believe that non-pharmacological options are the safer way to go?

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