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The British Journal of Psychiatry The British Journal of Psychiatry

Article contents

Heroin-assisted treatment for opioid dependence

Randomised controlled trial

Published online by Cambridge University Press:  02 January 2018

Christian Haasen ,
Uwe Verthein ,
Peter Degkwitz ,
Juergen Berger ,
Michael Krausz  and
Dieter Naber
Christian Haasen*
Affiliation:
Centre for Interdisciplinary Addiction Research, University Medical Centre Eppendorf, Hamburg
Uwe Verthein
Affiliation:
Centre for Interdisciplinary Addiction Research, University Medical Centre Eppendorf, Hamburg
Peter Degkwitz
Affiliation:
Centre for Interdisciplinary Addiction Research, University Medical Centre Eppendorf, Hamburg
Juergen Berger
Affiliation:
Institute for Medical Biometrics and Epidemiology, University Medical Centre Eppendorf, Hamburg
Michael Krausz
Affiliation:
Centre for Interdisciplinary Addiction Research, University Medical Centre, Eppendorf, Hamburg, Germany
Dieter Naber
Affiliation:
Centre for Interdisciplinary Addiction Research, University Medical Centre, Eppendorf, Hamburg, Germany
*
Dr Christian Haasen, Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Centre Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Email: haasen@uke.uni-hamburg.de
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Abstract

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Background

Heroin-assisted treatment has been found to be effective for people with severe opioid dependence who are not interested in or do poorly on methadone maintenance.

Aims

To study heroin-assisted treatment in people on methadone who continue intravenous heroin and in those who are heroin dependent but currently not in treatment.

Method

In an open-label multicentre randomised controlled trial, 1015 people with heroin dependence received a variable dose of injectable heroin (n=515) or oral methadone (n=500) for 12 months. Two response criteria, improvement of physical and/or mental health and decrease in illicit drug use, were evaluated in an intent-to-treat analysis.

Results

Retention was higher in the heroin (67.2%) than in the methadone group (40.0%) and the heroin group showed a significantly greater response on both primary outcome measures. More serious adverse events were found in the heroin group, and were mainly associated with intravenous use.

Conclusions

Heroin-assisted treatment is more effective for people with opioid dependence who continue intravenous heroin while on methadone maintenance or who are not enrolled in treatment. Despite a higher risk, it should be considered for treatment resistance under medical supervision.

Type
Papers
Information
The British Journal of Psychiatry , Volume 191 , Issue 1 , July 2007 , pp. 55 - 62
Copyright
Copyright © Royal College of Psychiatrists, 2007 

Footnotes

Declaration of interest

None. Funding detailed in Acknowledgements.

References

Ali, R., Auriacombe, M., Casas, M., et al (1999) Report of the external panel on the evaluation of the Swiss scientific studies of medically prescribed narcotics to drug addicts. Sucht, 45, 160–70.Google Scholar
Bammer, G., Dobler-Mikola, A., Fleming, P. M., et al (1999) Prescription heroin to dependent users: integrating science and politics. Science, 284, 1277–1278.CrossRefGoogle Scholar
Blanken, P., Hendriks, V. M., Koeter, M. W., et al (2005) Matching of treatment-resistant heroin dependent patients to medical prescription of heroin or oral methadone treatment: results from two randomized controlled trials. Addiction, 100, 89–95.CrossRefGoogle ScholarPubMed
Bühringer, G., Adelsberger, F., Heinemann, A., et al (1997) Schtzverfahren und Schtzungen 1997 zum Umfang der Drogenproblematik in Deutschland [Estimation method and estimates 1997 on the extent of the drug problem in Germany]. Sucht, 43 (suppl. 2), 78–143.Google Scholar
Darke, S., Ward, J., Zador, D., et al (1991) A scale for estimating the health status of opioid users. British Journal of Addiction, 86, 1317–1322.CrossRefGoogle ScholarPubMed
Darke, S., Hall, W., Wodak, A., et al (1992) Development and validation of a multidimensional instrument for assessing outcome of treatment among opiate users: the Opiate Treatment Index. British Journal of Addiction, 87, 733–742.CrossRefGoogle Scholar
Derogatis, L. R. (1983) SCL-90-R: Administration, Scoring and Procedures (manual II). Clinical Psychometric Research.Google Scholar
Dijkgraaf, M. G., van der Zanden, B. P., de Borgie, C. A., et al (2005) Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials. BMJ, 330, 1297–1302.Google Scholar
Farnbacher, G., Basdekis-Josza, R., Krausz, M. (2002) Psychoedukation als Methode in der Drogenhilfe. In Drogenpraxis Drogenrecht Drogenpolitik [Psychoeducation as a method in addiction services. In Practice, Legislation and Policy on Drugs]. (eds Böllinger, L. & Stöver, H.), pp. 386–402. Fachhochschulverlag.Google Scholar
Ferri, M., Davoli, M. & Perucci, C. A. (2005) Heroin maintenance for chronic heroin dependents. Cochrane Library, issue 2. Wiley Interscience.Google Scholar
Gossop, M. (1990) The development of a Short Opiate Withdrawal Scale (SOWS). Addictive Behaviours, 15, 487–490.CrossRefGoogle Scholar
Kokkevi, A. & Hartgers, C. (1995) EuropASI: European adaptation of a multidimensional assessment instrument for drug and alcohol dependence. European Addiction Research, 1, 208–210.CrossRefGoogle Scholar
Oliva, H., Görgen, W., Schlanstedt, G., et al (2001) Case Management in der Suchtkranken- und Drogenhilfe [Case Management in Addiction Services]. Nomos.Google Scholar
Paterson, S., Lintzeris, N., Mitchell, T. B., et al (2005) Validation of techniques to detect illicit heroin use in patients prescribed pharmaceutical heroin for the management of opioid dependence. Addiction, 100, 1832–1839.CrossRefGoogle ScholarPubMed
Perneger, T. V., Giner, F., del Rio, M., et al (1998) Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments. BMJ, 317, 13–18.CrossRefGoogle ScholarPubMed
Raschke, P., Püschel, K. & Heinemann, A. (2000) Rauschgiftmortalität und Substitutionstherapie in Hamburg (1990–1998) [Narcotics mortality and maintenance treatment in Hamburg (1990–1998)]. Suchttherapie, 1, 43–48.CrossRefGoogle Scholar
Rathod, N. H., Addenbrooke, W. M. & Rosenbach, A. F. (2005) Heroin dependence in an English town: 33-year follow-up. British Journal of Psychiatry, 187, 421–425.CrossRefGoogle Scholar
Rehm, J., Gschwend, P., Steffen, T., et al (2001) Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: a follow-up study. Lancet, 358, 1417–1420.CrossRefGoogle ScholarPubMed
Rook, E., Huitema, A., van den Brink, W., et al (2006) Screening for illicit heroin use in patients in a heroin-assisted treatment program. Journal of Analytical Toxicology, 30, 390–394.CrossRefGoogle Scholar
Rounsaville, B. J. (1993) Rationale and guidelines for using comparable measures to evaluate substance abusers: an overview. In Diagnsotic Source Book on Drug Abuse Research and Treatment (eds Rounsaville, B. J., Tims, F. M., Horton, A. M., et al), pp. 1–10. US Department of Health and Human Services.Google Scholar
van den Brink, W., Hendriks, V. M., Blanken, P., et al (2003) Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials. BMJ, 327, 310–312.CrossRefGoogle ScholarPubMed
World Health Organization (1990) Composite International Diagnostic Interview (CIDI). (German version). Wittchen & Semler.Google Scholar
World Health Organization (1993) The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. WHO.Google Scholar
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