The British Journal of Psychiatry (2007) 191: 55-62. doi: 10.1192/bjp.bp.106.026112
© 2007 The Royal College of Psychiatrists
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Heroin-assisted treatment for opioid dependence

Randomised controlled trial

Christian Haasen, MD, Uwe Verthein, PhD and Peter Degkwitz, PhD

Centre for Interdisciplinary Addiction Research, University Medical Centre Eppendorf, Hamburg

Juergen Berger, PhD

Institute for Medical Biometrics and Epidemiology, University Medical Centre Eppendorf, Hamburg

Michael Krausz, MD and Dieter Naber, MD

Centre for Interdisciplinary Addiction Research, University Medical Centre, Eppendorf, Hamburg, Germany

Correspondence: Dr Christian Haasen, Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Centre Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Email: haasen{at}uke.uni-hamburg.de

Declaration of interest None.

Funding detailed in Acknowledgements.

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.

Aims 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.

Method 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.


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eLetters:

Read all eLetters

Important findings for heroin treatment but treatment retention not one of them
Andrew Al-Adwani, et al.
BJP Online, 5 Jul 2007 [Full text]
Response to letter „Important findings for heroin treatment but treatment retention not one of them"
Christian Haasen
BJP Online, 7 Sep 2007 [Full text]