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={John Strang and Nicola Metrebian and Nicholas Lintzeris and Laura C. Potts and Tom Carnwath and Soraya Mayet and Hugh Williams and Deborah A Zador and Richard Evers and Teodora Groshkova and Vikki Charles and Anthea Martin and Luciana Forzisi},
  journal={The Lancet},
  year={2010},
  volume={375},
  pages={1885-1895}
}

Figures and Tables from this paper

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
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.

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).

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.

Cost-effectiveness of injectable opioid treatment v. oral methadone for chronic heroin addiction

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.

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.

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.

After the randomised injectable opiate treatment trial: post-trial investigation of slow-release oral morphine as an alternative opiate maintenance medication.

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.

Supervised Injectable Heroin: A Clinical Perspective

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.

History of Treatment Access and Drug Use among Participants in a Trial Testing Injectable Opioids under Supervision for Long-Term Heroin Injectors

The baseline characteristics of participants’ baseline characteristics in a study comparing injectable diacetylmorphine and hydromorphone and factors independently associated with prior access to methadone at high doses were described to fit the profile of patients to whom supervised injectable treatment should be offered.

Supervised Injectable Opioid Treatment for the Management of Opioid Dependence

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.

Heroin maintenance for chronic heroin-dependent individuals.

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.

Heroin on trial: Systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction

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 improve the impact of comprehensive healthcare provision.
...

References

SHOWING 1-10 OF 40 REFERENCES

Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials

Supervised coprescription of heroin is feasible, more effective, and probably as safe as methadone alone in reducing the many physical, mental, and social problems of treatment resistant heroin addicts.

Randomized trial of supervised injectable versus oral methadone maintenance: report of feasibility and 6-month outcome.

AIM To assess the feasibility of a randomized clinical trial of supervised injectable versus oral methadone maintenance and to assess medium-term treatment outcomes. DESIGN Randomized clinical

Heroin-assisted treatment for opioid dependence: randomised controlled trial.

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.

Prescribing drug of choice to opiate dependent drug users: a comparison of clients receiving heroin with those receiving injectable methadone at a West London drug clinic

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.

Diacetylmorphine versus methadone for the treatment of opioid addiction.

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.

Heroin maintenance for chronic heroin dependents.

Assessment of the efficacy and acceptability of heroin maintenance versus methadone or other substitution treatments for opioid dependence, in retaining patients in treatment; reducing the use of illicit substances and improving health and social functioning and no definitive conclusions are possible.

Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments

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.

Prescription of Heroin for the Management of Heroin Dependence

There is increasing consensus that heroin treatment is suited to a minority of heroin users as a second-line treatment for those individuals who do not respond to methadone or buprenorphine treatment delivered under optimal conditions.

Patients prescribed injectable heroin or methadone -their opinions and experiences of treatment.

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.