title: Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments.
abstract: OBJECTIVE
  To evaluate an experimental heroin maintenance programme.
  
  
  METHODS
  Randomised trial.
  
  
  METHODS
  Outpatient clinic in Geneva, Switzerland.
  
  
  METHODS
  Heroin addicts recruited from the community who were socially marginalised and in poor health and had failed in at least two previous drug treatments.
  
  
  METHODS
  Patients in the experimental programme (n=27) received intravenous heroin and other health and psychosocial services. Control patients (n=24) received any other conventional drug treatment (usually methadone maintenance).
  
  
  METHODS
  Self reported drug use, health status (SF-36), and social functioning.
  
  
  RESULTS
  25 experimental patients completed 6 months in the programme, receiving a median of 480 mg of heroin daily. One experimental subject and 10 control subjects still used street heroin daily at follow up (difference 44%; 95% confidence interval 16% to 71%). Health status scores that improved significantly more in experimental subjects were mental health (0.58 SD; 0.07 to 1.10), role limitations due to emotional problems (0.95 SD; 0.11 to 1.79), and social functioning (0.65 SD; 0.03 to 1.26). Experimental subjects also significantly reduced their illegal income and drug expenses and committed fewer drug and property related offences. There were no benefits in terms of work, housing situation, somatic health status, and use of other drugs. Unexpectedly, only nine (38%) control subjects entered the heroin maintenance programme at follow up.
  
  
  CONCLUSIONS
  A heroin maintenance programme is a feasible and clinically effective treatment for heroin users who fail in conventional drug treatment programmes. Even in this population, however, another attempt at methadone maintenance may be successful and help the patient to stop using injectable opioids.
authors.affiliation: Institute of Social and Preventive Medicine, University of Geneva Medical School, CH-1211 Geneva 4, Switzerland. perneger@cmu.unige.ch
authors.forename: T V
authors.initials: TV
authors.lastname: Perneger
authors.forename: F
authors.initials: F
authors.lastname: Giner
authors.forename: M
authors.initials: M
authors.lastname: del Rio
authors.forename: A
authors.initials: A
authors.lastname: Mino
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D003932:Heroin / Q000008:administration & dosage*; D006556:Heroin Dependence / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D013287:Illicit Drugs; D007182:Income; D007262:Infusions, Intravenous; D007398:Interpersonal Relations; D008297:Male; D009294:Narcotics / Q000008:administration & dosage*; D013557:Switzerland
chemical_list: D013287:Illicit Drugs; D009294:Narcotics; D003932:Heroin