Heroin-assisted treatment for opioid dependence: randomised controlled trial.
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.
Haasen
Christian
C
Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Centre Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. haasen@uke.uni-hamburg.de
Verthein
Uwe
U
Degkwitz
Peter
P
Berger
Juergen
J
Krausz
Michael
M
Naber
Dieter
D
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
D009294:Narcotics; D003932:Heroin; D008691:Methadone