HEROIN "VS" METHADONE: flawed trial methodology

Several prominent trials in recent years have demonstrated quite convincingly that heroin maintenance is feasible and associated with favorable outcomes. The problem arises when comparisons are made between heroin and methadone, since the difference between "subjects" receiving heroin and "controls" who are given methadone couldn't be greater. This is made clear by the following headline and first paragraph of a report in Der Tagespiegel of 13 April (http://archiv.tagesspiegel.de/archiv/13.04.2006/2469331.asp):

"DRUGS BY PRESCRIPTION: HEROIN INSTEAD OF METHADONE TO HELP LONG-TERM ADDICTS? THIS IS SUGGESTED BY RESULTS OF A LARGE STUDY
Sven-Uwe sits in a Hamburg drug clinic where he participates in a heroin trial, and smiles. He feels like he's won the jackpot. He was picked at random to receive heroin, and not the control group that gets methadone. Like almost all other subjects, this trained carpenter, with a history of 20 years of opiate dependence, has had several failed attempts with methaodne treatment behind him."

In other words, the comparison is between the effects of heroin maintenance, which is what motivates volunteers to participate in the trial, and methadone, which they not only don't want but which has proven(repeatedly for most) to be unsuccessful.

The rationale that's been given for this methodology in Germany, Canada and elsewhere is that there's an ethical obligation to test a proposed new treatment against "the best currently available" treatment - and for opiate dependence that's clearly methadone maintenance. The rationale, however, does not apply to this particular group of subjects. There is no evidence to suggest that for those who have repeatedly failed to benefit from methadone maintenance, methadone remains the most promising treatment. Maybe long-acting codeine (used in Germany for years before methadone was legal) would be a better choice, or acupuncture, or buprenorphine, or whatever. There's no basis for believing methadone is "best" for these individuals, and given its prior ineffectiiveness common sense suggests it's not.

Basically, this is flawed science, leading to unjustified conclusions, that very likely will add to the bias against methadone as a medication - one among many! - for opioid dependence.