NEWS: Herald Sun - 23/01/2007 'Genetic help for addicts'

Genetic help for addicts
January 23, 2007 12:00am

THE success of methadone treatment could skyrocket after Australian scientists uncovered the genetic key to stop heroin addicts slipping off the drug substitute.
A team from the University of Adelaide has found a gene that controls how quickly the drug replacement is transported around the body.

By testing heroin addicts, they discovered that people with a mutation of the gene -- about 25 per cent of the population -- can cope on lower doses of methadone.

But the majority without the mutation process methadone faster and need almost double the amount to stave off heroin withdrawal.

The research is the first to investigate the problem of inaccurate dosing, which sees almost two out of every three methadone users drop out of programs prematurely.

Most fail in the first four weeks of the treatment, when the withdrawal effects are most severe.

"It's entirely possible the people who are failing are doing so because their genotype is such that they need more methadone than they're getting," says Dr Janet Coller, pharmacologist and lead researcher of the study.

The study appears in the Clinical Pharmacology and Therapeutics journal.

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Herald Sun

^I'd like to see the actual research article. As it reads here, it barely makes sense. It's pretty easy to titrate someone's dose, simply based on the effects of the previous dose. You don't need genetic testing for that!

Yeah it just sounds like another reason for addicts to not quit.

"I can't quit because I have bad genes"

Well, we know that metabolism of some other drugs - particularly some of the opioids - can be affected by genetic disposition, so I don't find this so surprising. I've also known two heroin addicts who required massive doses of methadone in order to successfully quit heroin (one took 250 ml, twice a day). I had assumed it was because of their heroin habit i.e. it related to the amount of heroin they had dosed with, but perhaps this may offer a better explanation.

But yes, I'd also like to see the original article. If someone with access could dig it up, it would be much appreciated.

^trust you mean 250 mg , not 250ml - at 5mg/ml, that's quite a wallop! Even 250mg is enormous though!

^It may well have been ayjay, although it was in a larger sized bottle which, from memory looked like 200-250ml to me. The girl had claimed it was 250ml.

I met this person through my work as an electronic tech. I was repairing a car stereo for her and she was waiting in my workshop when she started to shake, explaining that she was overdue for her morning dose of methadone.

She said she received 2 bottles / day but only one at a time, so she had to return to the clinic in the early afternoon for her second. She was supposed to sip it continually through the day, but instead would hang out for a few hours before downing each bottle in one go. She remarked that she was a special case, having had such a massive heroin habit before moving up here and getting on the program. She also claimed to have been an H user since her early teens (she was ~28-30 when I met her, although could be mistaken for someone much older).

Looking at the MIMS entry, 80mg/day seems to be the stated maximum, so how she would have been allocated this amount is anyone's guess.

As she got more shaky she pulled out the bottle and downed it, stopping short at around 10mL. She then asked if I had ever tried it. I said no, so she offered the remaining bit which I took. I definitely regretted it, as I found it an absolutely horrible experience. But then again, opioids do virtually nothing for me euphoria wise and although chemically different, I should have expected I'd be disappointed.

As a side note, some weeks later this girl was involved in an accident where she hit a 4 year old crossing the street. The kid was only slightly injured, but a blood test revealed she had very high levels of a number of pharmaceutical and illicit drugs in her blood. It made for a much talked about story in our local newspaper, and as can be imagined she was shunned by many locals - even users - as she continued to drive intoxicated without a licence. She hung around town for some time until she was setup by an undercover who posed as her live-in boyfriend. Being Qld in the late 80's, that case ended in her getting off due to entrapment - another local news feature. After that she left town. We felt the streets were definitely safer.

^Different states have different practices around methadone dispensing, and methadone takeaway dispensing. I don't really know about QLD - but it sounds like she was pulling your leg a little.

Certainly in NSW and Vic, the majority of methadone doses are taken in a supervised setting - at a clinic or pharmacy, and all at once. There are provisions to access takeaway doses, but it is not the norm. In Vic, the guidelines state that methadone is dispensed diluted with cordial to 200ml (so could compare to the bottle you describe above). This is to prevent injection, which is fairly prevalent in NSW.

Methadone in Australia for opiate maintenance treatment comes in only 2 forms - methadone syrup (5mg/ml) and Biodone (also 5mg/ml, but with a nice red colouring and no sweetener added).

As with all prescription opiates, there is a healthy black market in methadone too - it sounds like the person in your anecdote was "self-medicating", rather than actually being prescribed such a gigantic dose.

If you look again at the original article, the majority of people will metabolise methadone at the faster rate. Your anecdote seems to be about something else entirely - although I would not dispute that there is some genetic basis for the behaviour described (or in fact any behaviour!)