Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial

@article{Strang2010SupervisedIH,
  title={Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial},
  author={J. Strang and N. Metrebian and N. Lintzeris and L. Potts and T. Carnwath and S. Mayet and H. Williams and D. Zador and Richard Evers and Teodora Groshkova and V. Charles and Anthea Martin and Luciana Forzisi},
  journal={The Lancet},
  year={2010},
  volume={375},
  pages={1885-1895}
}
BACKGROUND Some heroin addicts persistently fail to benefit from conventional treatments. We aimed to compare the effectiveness of supervised injectable treatment with medicinal heroin (diamorphine or diacetylmorphine) or supervised injectable methadone versus optimised oral methadone for chronic heroin addiction. METHODS In this multisite, open-label, randomised controlled trial, we enrolled chronic heroin addicts who were receiving conventional oral treatment (>or=6 months), but continued… Expand
Supervised injectable heroin better at reducing street heroin use than supervised injectable methadone or optimised oral methadone
  • J. Rehm
  • Medicine
  • Evidence Based Mental Health
  • 2010
TLDR
Heroin-assisted treatment, that is, the use of injectable or oral medical heroin for the purpose of treatment of refractory opioid addicts, has again been shown effective compared to the existing gold standard of optimal methadone treatment, this time in UK settings. Expand
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).
TLDR
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. Expand
Cost-effectiveness of injectable opioid treatment v. oral methadone for chronic heroin addiction
TLDR
Injectable opioid treatments are more cost-effective than optimised oral methadone for chronic refractory heroin addiction and the choice between supervised injectable heroin and injectable Methadone is less clear. Expand
Treatment expectations and satisfaction of treatment-refractory opioid-dependent patients in RIOTT, the Randomised Injectable Opiate Treatment Trial, the UK's first supervised injectable maintenance clinics.
TLDR
Patients previously considered non-responsive to treatment appear to have similar treatment expectations and aspirations as other drug users in treatment, andSupervised injectable opioid treatment patients consistently reported treatment satisfaction but also that more could be done to optimise aspects of current arrangement. Expand
After the randomised injectable opiate treatment trial: post-trial investigation of slow-release oral morphine as an alternative opiate maintenance medication.
TLDR
Slow-release oral morphine (SROM) is a valuable alternative which enabled some patients to reduce both their dose and number of injections of diamorphine and may represent a route to stop injecting. Expand
Supervised Injectable Heroin: A Clinical Perspective
TLDR
Prescribed heroin is sufficiently motivating to hold a proportion of recidivist addicts in long-term treatment and develop sufficient rewards from social reintegration to successfully withdraw from treatment. Expand
History of Treatment Access and Drug Use among Participants in a Trial Testing Injectable Opioids under Supervision for Long-Term Heroin Injectors
Background: For opioid-dependent patients not benefitting from conventional treatments (i.e., oral methadone), evidence suggests that supervised injectable medications are effective. The presentExpand
Supervised Injectable Opioid Treatment for the Management of Opioid Dependence
TLDR
Critical, unresolved issues concerning this modality of treatment relate to the way in which it is approached—either as a medium-term, intensive intervention where other treatment has failed, designed to bring people into conventional opioid agonist treatment (OAT); or an indefinite support aimed at reducing social and personal harm. Expand
Heroin maintenance for chronic heroin-dependent individuals.
TLDR
The available evidence suggests an added value of heroin prescribed alongside flexible doses of methadone for long-term, treatment refractory, opioid users, to reach a decrease in the use of illicit substances, involvement in criminal activity and incarceration, a possible reduction in mortaliity; and an increase in retention in treatment. Expand
Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction†.
TLDR
SIH is found to be an effective way of treating heroin dependence refractory to standard treatment, and inclusion of this low-volume, high-intensity treatment can now improve the impact of comprehensive healthcare provision. Expand
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TLDR
The Randomised Injectable Opioid Treatment Trial (RIOTT) is a multisite, prospective open-label randomised controlled trial examining the role of treatment with injected opioids (methadone and heroin) for the management of heroin dependence in patients not responding to conventional substitution treatment. Expand
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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, and should be considered for treatment resistance under medical supervision. Expand
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TLDR
Fifty-eight long-term treatment resistant opiate-dependent drug users were offered the choice of receiving injectable heroin or injectable methadone at a West London drug clinic, and one-third chose injectable Methadone. Expand
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Injectable diacetylmorphine maintenance therapy was more effective than oral methadone in patients with opioid dependence that was refractory to treatment and should be delivered in settings where prompt medical intervention is available. Expand
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TLDR
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TLDR
A heroin maintenance programme is a feasible and clinically effective treatment for heroin users who fail in conventional drug treatment programmes and may be successful and help the patient to stop using injectable opioids. Expand
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TLDR
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TLDR
The findings suggest that clinicians and policy makers should be aware of many heroin users' perception of IOT as long-term treatment and their clear preference for injectable diamorphine. Expand
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