Supervised injectable heroin leads to lower use of street heroin

January 01, 0001

Supervised injectable heroin leads to lower use of street heroin

Some heroin addicts persistently fail to benefit from conventional treatments. The researchers from the UK aimed to compare the effectiveness of supervised injectable treatment with medicinal heroin (diamorphine or diacetylmorphine) or supervised injectable methadone versus optimised oral methadone for chronic heroin addiction. In this multisite, open- label, randomised controlled trial, they enrolled chronic heroin addicts who were receiving conventional oral treatment (=6 months), but continued to inject street heroin regularly (=50% of days in preceding 3 months). Randomisation by minimisation was used to assign patients to receive supervised injectable methadone, supervised injectable heroin, or optimised oral methadone. Treatment was provided for 26 weeks in three supervised injecting clinics in England. Primary outcome was 50% or more of negative specimens for street heroin on weekly urinalysis during weeks 14—26.

Patients on injectable heroin were significantly more likely to have achieved the primary outcome (72%) than were those on oral methadone (27%, significant), with number needed to treat of 2.17. For injectable methadone versus oral methadone, the difference was not significant. For injectable heroin versus injectable methadone, a significant difference was recorded, but the study was not powered for this comparison. Differences were evident within the first 6 weeks of treatment.

The researchers concluded: "Treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone. UK Government proposals should be rolled out to support the positive response that can be achieved with heroin maintenance treatment for previously unresponsive chronic heroin addicts."

An example of politics and policies augmenting medical management outcomes.

For the full abstract, click here.

The Lancet 375 (9729):1885-1895, 29 May 2010
© Elsevier Ltd 2010
Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial. John Strang, Nicola Metrebian, Nicholas Lintzeris et al. Correspondence to John Strang: [email protected]

Category: Z. Social Problems, HSR. Health Services Research. Keywords: supervised, injectable, heroin, methadone, oral, treatment, addicts, multisite open-label randomised controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 18 June 2010

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