Methadone or buprenorphine - disagreements over drug therapy for addicts

Helsinki user says only buprenorphine makes normal life possible

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First he had problems remembering things, and then he gained weight.
      Two years were spent in a semi-somnambulant state brought on by his daily dose of methadone.
      “But when I stopped, my eyes were brightened, and my body woke up”, says 34-year-old Anssi Iso-Heiniemi.
     
The issue at hand is not illegal drug use – it’s about replacement therapy.
      “I have the very strong view that methadone really is the wrong medicine for those who want to return to society.”
      Currently there are two options for drug replacement therapy for heroin addicts: methadone and buprenorphine. These are administered to about 600 people in Helsinki.
     
Helsinki buys more than half of its treatment from the private sector – the Helsinki Deaconess Institute and the A-Clinic Foundation. Each patient costs the city about EUR 10,000 a year.
      Doctors assess which of the two drugs is most suitable for opiate addicts. At present, nearly two thirds get methadone, but the popularity of buprenorphine is growing.
     
Bucking the trend is Pekka Tuomola, head of the service area of the Deaconess Institute, who prefers methadone maintenance.
      Tuomola says that abuse of buprenorphine has become a problem only in Finland and he says that the substance has not been studied sufficiently. He also notes that it is much more expensive than methadone.
     
In the view of Pekka Heinälä, head physician of the A-Clinic Foundation, both drugs have benefits.
      “Why a certain substance is suitable for certain people, I think nobody knows.”
      Heinälä says that the price difference is not a problem. The national economy benefits if an addict stops committing crimes to feed his or her habit.
     
Executive director Johan Loikas of the anti-drug group Stop huumeille opposes the use of both drugs. He says that they are physically harmful, which means that there is a time bomb ticking in drug treatment.
      “Therapy is needed immediately to shake off addiction, rather than waiting for thousands to rot from the inside in our health care in the future”, Loikas warns.
      “Both medicines are quite OK in theory, if they were given in an enclosed space in such a way that the use of the drug is gradually reduced to zero.
     
Loikas says that drugs used in replacement therapy are being diverted to street sales, and many are starting their use of drugs with them.
     
Anssi Iso-Heiniemi says that the quality of his life improved considerably when he switched over to buprenorphine. He says that now he can live a normal life again.
      The situation of his wife is different. Iso-Heiniemi says that she is “irrevocably on methadone”.
     
The advantages of buprenorphine are that it is relatively safe, if used correctly, and increasing the dose does not increase the effect.
      However, it is also expensive – a daily dose administered by the Deaconess institute costs about ten euros. It is also slow to administer, as it is usually taken by allowing a pill to dissolve under the tongue.
      It also has a potential for abuse, with some people crushing the pills and using it intravenously.
     
Methadone has been used for a longer time for replacement and maintenance therapy. It is cheap – a daily dose from the Deaconess Institute costs about 50 cents.
      Administering methadone is quick: it is a liquid that users drink.
      Disadvantages include a large potential for overdose, physical deterioration of the user, and a tendency of users to fear the substance.


Links:
  Buprenorphine (Wikipedia)
  Methadone (Wikipedia)

Helsingin Sanomat