Beyond traditional treatment programs (see Treatment) that help heroin addicts quit altogether, three alternative methods exist.
These less conventional treatments are less ambitious in their ultimate goal, recognizing the fact that the vast majority of heroin addicts who try traditional treatment ultimately relapse. In fact, one study from 2013 found that 78% of addicts in rehab for heroin addiction had already been there at least once, and 27% had been in recovery at least five times. The two more common treatments in the U.S. use methadone and buprenorphine (i.e. Suboxone), while the third type, heroin maintenance, remains more controversial.
Methadone is essentially a substitute for morphine, and although its chemical composition is different, it has similar effects for reducing severe pain. The major difference is that its effects last longer, up to 24 hours. German scientists invented methadone during World War II when morphine became scarce. Yet, it was not used to treat heroin addiction until the 1960s, becoming one of the first substitution therapies.
Buprenorphine offers another treatment option for those with less intense opiate addiction. The medication is usually prescribed by a physician and administered directly by the patient, but only works as part of a comprehensive treatment program that includes counseling. The ultimate goal is not to rid the addict from drug dependency, but rather to substitute a drug like methadone or buprenorphine for a more dangerous drug like heroin. Hence, the name, methadone maintenance. Unfortunately, successful outcomes are less encouraging as the majority of methadone patients become just as dependent on methadone. Also, most patients return to heroin, especially in the U.S., where heroin has become incredibly cheap and widely available.
More controversial is heroin maintenance, where the main goals are to prevent addicts from overdosing and sharing dirty needles by administering minimal but steady doses of heroin. Such treatments have been used in countries like Switzerland, but are less common in the U.S., where to-date there are less than a dozen trials being conducted. Thus far, the results for heroin maintenance are no better than methadone treatment and many patients return to addiction and even overdose.