title: Heroin-assisted treatment for opioid dependence: randomised controlled trial.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Centre Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. haasen@uke.uni-hamburg.de
authors.forename: Christian
authors.initials: C
authors.lastname: Haasen
authors.forename: Uwe
authors.initials: U
authors.lastname: Verthein
authors.forename: Peter
authors.initials: P
authors.lastname: Degkwitz
authors.forename: Juergen
authors.initials: J
authors.lastname: Berger
authors.forename: Michael
authors.initials: M
authors.lastname: Krausz
authors.forename: Dieter
authors.initials: D
authors.lastname: Naber
mesh_terms: D000328:Adult; D000465:Algorithms; D005260:Female; D003932:Heroin / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000534:rehabilitation*; D011613:Psychotherapy; D016896:Treatment Outcome
chemical_list: D009294:Narcotics; D003932:Heroin; D008691:Methadone