title: Drug use, health and social outcomes of hard-to-treat heroin addicts receiving supervised injectable opiate treatment: secondary outcomes from the Randomized Injectable Opioid Treatment Trial (RIOTT).
abstract: OBJECTIVE
  The Randomized Injectable Opioid Treatment Trial (RIOTT) compared supervised injectable heroin (SIH) and supervised injectable methadone (SIM) with optimized oral methadone (OOM) (ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes.
  
  
  METHODS
  Multi-site randomized controlled trial (RCT) comparing SIH versus OOM and SIM versus OOM.
  
  
  METHODS
  Three supervised injectable opiate clinics in England.
  
  
  METHODS
  Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment (n = 127), randomized to either SIH(n = 43), SIM(n = 42) or OOM(n = 42). All received high levels of medical and psychosocial support.
  
  
  METHODS
  
  
  
  RESULTS
  wider drug use, crime, health and social functioning at 6 months.
  
  
  RESULTS
  At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health (SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [SIH = odds ratio (OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs (SIH = mean change £-289.43; P < 0.001; SIM = mean change £-183.41; P < 0.001; OOM = mean change £-162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £-92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM (SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013).
  
  
  CONCLUSIONS
  Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes.
authors.affiliation: Addictions Department, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Metrebian
authors.forename: Teodora
authors.initials: T
authors.lastname: Groshkova
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hellier
authors.forename: Vikki
authors.initials: V
authors.lastname: Charles
authors.forename: Anthea
authors.initials: A
authors.lastname: Martin
authors.forename: Luciana
authors.initials: L
authors.lastname: Forzisi
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
authors.forename: Deborah
authors.initials: D
authors.lastname: Zador
authors.forename: Hugh
authors.initials: H
authors.lastname: Williams
authors.forename: Tom
authors.initials: T
authors.lastname: Carnwath
authors.forename: Soraya
authors.initials: S
authors.lastname: Mayet
authors.forename: John
authors.initials: J
authors.lastname: Strang
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D015897:Comorbidity; D003415:Crime / Q000706:statistics & numerical data; D004651:Employment / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006304:Health Status; D003932:Heroin / Q000008:administration & dosage; D006556:Heroin Dependence / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D013287:Illicit Drugs; D007275:Injections, Intravenous; D007398:Interpersonal Relations; D016014:Linear Models; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D018671:Needle-Exchange Programs; D058850:Opiate Substitution Treatment / Q000379:methods*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D013287:Illicit Drugs; D003932:Heroin; D008691:Methadone
keywords: Addiction; diamorphine; heroin; injectable opiate treatment; methadone; opiates; substance misuse