A long-acting heroin substitute similar to methadone is effective and should be more extensively utilized, according to a new study by researchers at Johns Hopkins University in Baltimore.

The study of levomethadyl acetate hydrochloride, or LAAM, was published in the August issue of Archives of General Psychiatry. Rolley E. Johnson, Pharm.D., an associate professor of psychiatry, and colleagues gave 180 heroin addicts either low, medium, or high doses of LAAM, phasing in the drug over 17 days. Heroin use dropped significantly in the high-dose group, which showed a decline of more than 80 percent in self-reported heroin use, but that group also had the most dropouts from the study. Researchers evaluated urine samples to help verify self-reports.

The dropouts were caused by side effects that occur at high doses, said Johnson. But he suggested that further studies could help pinpoint an optimal dose that minimizes side effects and maximizes heroin abstinence.

LAAM was approved by the Food and Drug Administration in 1993 but has been shunned by treatment providers because it is somewhat more complicated to use than methadone, according to Herbert Kleber, M.D., a member of APA's Council on Addiction Psychiatry and medical director of the National Center on Addiction and Substance Abuse at Columbia University. Only 3,000 U.S. patients are receiving LAAM, according to Johns Hopkins, versus 115,000 receiving methadone, according to the federal Office of National Drug Control Policy.

"I believe LAAM is a very underutilized treatment for heroin addiction," said Kleber. Unlike methadone, no take-home use of LAAM is permitted, observed Kleber. The "initial dosing is somewhat more difficult and requires more in the way of medical staffing" than methadone programs, he added. "Many methadone programs these days do not have adequate medical staffing." There is also resistance to trying something new.

"Eventually, I think that LAAM [maintenance] should replace one-third to a half of methadone maintenance."

Who needs to be convinced? "It's the people out there running the programs," remarked Kleber. Since LAAM is both new and harder to use, it requires more medical sophistication, and many methadone programs lack that sophistication, he noted. "But I'm not willing to let them off the hook."

LAAM, "with its longer action, is promising," remarked Richard Frances, M.D., chair of the Public Policy Committee of the American Academy of Addiction Psychiatry and consultant to the APA Council on Addiction Psychiatry.

The Archives of General Psychiatry Web site is www.ama-assn.org/public/journals/psyc/.