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Long-term methadone and buprenorphine maintenance are mainstays of heroin addiction treatment. These medications bind to the same opioid receptors in the brain as does heroin, reducing cravings for and use of the deadly drug. But a new study shows that an alternative to medications that substitute for heroin in the brain can be highly effective by blocking the drug's effect on opioid receptors.

The research team, which was led by Lars Tanum of the Norwegian Center for Addiction Research, randomly assigned 159 opioid-addicted individuals to drug counseling, combined with either daily buprenorphine maintenance or monthly injections of extended-release naltrexone. Because naltrexone stops heroin and other opioids from binding at the opioid receptor, it makes drug use less rewarding and therefore easier to quit.

Three months after treatment began, the vast majority of patients receiving either medication had used no heroin or other illicit opioids in the past month (see table).  However, the rate of abstinence was statistically higher for patients on extended-release naltrexone.

Drug-addicted individuals are deeply stigmatized — indeed, often despised — and often their perceptions of the treatment they receive are not assessed or valued under the faulty logic of “who cares what a drug addict thinks?” But Tanum and colleagues wisely made such an assessment and found that extended-release naltrexone patients were more satisfied with their care and were more likely to recommend it to others than were patients on buprenorphine maintenance.

Tanum said that many patients told him that extended-release naltrexone “made them feel protected against relapse and overdose, even if they should be tempted to try opioids. They also appreciated not having to meet daily or every second day to receive supervised maintenance medication.”

Given its effectiveness and appeal to patients, extended-release naltrexone clearly deserves a place alongside methadone and buprenorphine in opioid addiction treatment. As recommended both by the U.S. Surgeon General and the White House Commission on the Opioid Crisis, expanding access to all three of these medications should be central to the health-care system’s response to the opioid epidemic.