Longer-lasting options to treat drug addiction

WASHINGTON - New treatments for addiction to heroin or narcotic painkillers promise longer-lasting relief that may remove some day-to-day uncertainty of care: A once-a-month shot is now approved, and a six-month implant is in final testing.

The main treatment options have long been once-a-day medications - methadone or a tablet named buprenorphine - that act as substitutes for the original drug, to suppress withdrawal and craving without the high.

Skipping a dose risks a relapse, but summoning the daily willpower to stick with treatment is "a formidable task," says Nora Volkow, director of the National Institute on Drug Abuse.

Last week, the Food and Drug Administration approved the monthly shot Vivitrol for long-term treatment of opioid addiction - to heroin or such painkillers as morphine, OxyContin, and Vicodin.

Vivitrol works differently from methadone or buprenorphine: It blocks the high if a recovering addict slips up, and it's not addictive.

Scientists had tried a daily version of Vivitrol's ingredient, naltrexone, years ago, but too many patients skipped pills. So Alkermes Inc. created the longer-lasting version first for alcoholism in 2006, and now opioid addiction. In a study of 250 opioid addicts in Russia, more than half of Vivitrol recipients stuck with therapy for the six-month trial. Better, 36 percent stayed completely drug-free, compared with 23 percent who received dummy shots.

Next in the pipeline: A matchstick-size implant that for six months at a time slowly oozes a low dose of buprenorphine into the bloodstream, to keep cravings tamped down. A large study published last week deemed the implant, called Probuphine, promising - just over a third of those patients, too, tested drug-free. Ongoing research partly funded by the government should show next spring if it's ready for FDA evaluation.Which approach will work best for which patient? Scientists don't know yet; there are pros and cons to daily and long-lasting versions. Early next year, the drug abuse institute will directly compare once-a-month Vivitrol to once-a-day buprenorphine and behavioral therapy alone to help tell.

But longer-lasting options promise to help keep patients on track longer.

"Opioid addicts are notoriously bad at complying with their medication. They like to take drug holidays. They like to party on the weekend," says Katherine Beebe of Titan Pharmaceuticals, developer of the Probuphine implant.

Long-acting options may help make substance-abuse treatment be more a part of mainstream medicine.

"To have these medications work effectively, you need to stay on them for long periods of time," says Patrick O'Connor of the Yale University School of Medicine.

"We are really struggling to get the public and physicians to think of this more like a standard chronic disease - like diabetes, like cancer, like chronic lung disease - and not apply a special stigma to it."

Source: Philly.cm Health News , By Lauran Neergaard "Associated Press"