Improved drug-addiction treatment options coming

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 the final testing phase.

The main treatment options have long been once-a-day medications, controversial methadone or buprenorphine tablets, which substitute 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 Dr. 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 addictions such as heroin and painkillers like morphine, OxyContin and Vicodin.

Vivitrol 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. Continuing 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. To help find out, NIDA will directly compare once-a-month Vivitrol to once-a-day buprenorphine and to behavioral therapy alone early next year.

About 800,000 people in the U.S. are addicted to heroin, and another 1.8 million either abuse or are dependent on opioid painkillers, Volkow says.