title: Craving and illicit heroin use among patients in heroin-assisted treatment.
abstract: OBJECTIVE
  To investigate in heroin-assisted treatment (HAT) compared to methadone maintenance treatment (MMT): the course of heroin craving and illicit heroin use, their mutual association, and their association with multi-domain treatment response.
  
  
  METHODS
  RCTs on the efficacy of 12 months co-prescribed injectable or inhalable HAT compared to 12 months continued oral MMT.
  
  
  METHODS
  Outpatient treatment in MMT- or specialized HAT-centers in the Netherlands.
  
  
  METHODS
  Chronic, treatment-refractory heroin dependent patients (n=73). STUDY PARAMETERS: General craving for heroin (Obsessive Compulsive Drug Use Scale); self-reported illicit heroin use; multi-domain treatment response in physical, mental and social health and illicit drug use.
  
  
  RESULTS
  The course of heroin craving and illicit heroin use differed significantly, with strong reductions in HAT but not in MMT. General heroin craving was significantly related to illicit heroin use. Heroin craving was not and illicit heroin use was marginally related to multi-domain treatment response, but only in MMT and not in HAT.
  
  
  CONCLUSIONS
  Heroin craving and illicit heroin use were significantly associated and both strongly decreased in HAT but not in MMT. Craving was not related to multi-domain treatment response and illicit heroin use was marginally related to treatment response in MMT, but not in HAT. The latter was probably due to the strong reduction in illicit heroin use in most patients in HAT and the small sample size of the sub-study. It is hypothesized that the strong reductions in craving for heroin in HAT are related to the stable availability of prescribed, pharmaceutical grade heroin.
authors.affiliation: Central Committee on the Treatment of Heroin Addicts (CCBH), University Medical Center Utrecht, Utrecht, The Netherlands. Peter.Blanken@Brijder.nl
authors.forename: Peter
authors.initials: P
authors.lastname: Blanken
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Hendriks
authors.forename: Maarten W J
authors.initials: MW
authors.lastname: Koeter
authors.forename: Jan M
authors.initials: JM
authors.lastname: van Ree
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
mesh_terms: D000328:Adult; D005260:Female; D003932:Heroin / Q000008:administration & dosage / Q000627:therapeutic use*; D006556:Heroin Dependence / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D010349:Patient Compliance / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009294:Narcotics; D003932:Heroin; D008691:Methadone