Treating Long-Term Addicts With Medical Grade Heroin More Effective Than Methadone

Editor's Choice
Main Category: Alcohol / Addiction / Illegal Drugs
Also Included In: Clinical Trials / Drug Trials
Article Date: 28 May 2010 - 9:00 PDT

email to a friend   printer friendly   opinions  

Medical grade heroin administered under medical supervision results in larger reductions in street heroin use in long-term (chronic) heroin addicts who are not responding properly to treatment, compared to either injectable or oral methadone, say researchers from The National Addiction Centre, Institute of Psychiatry (IoP), King's College Londond (KCL), who are involved in RIOTT (the Randomised Injectable Opiate Treatment Trial). The researchers explain that at least 5% to 10% of heroin addicts do not respond to established conventional treatments - however, nobody so far has been able to say whether or not they are untreatable.

A scientific evidence base is emerging to support the effectiveness of maintenance treatment with directly supervised medicinal heroin (diamorphine or diacetylmorphine) as a second-line treatment for chronic heroin addiction.

This randomised controlled trial monitored chronic (long-term) heroin addicts who were prescribed conventional oral treatment but continued regularly to inject themselves with street heroin. Patients were assigned to receive either:

• supervised injectable methadone
• supervised injectable heroin
• optimised oral methadone

The participants received treatment for 26 weeks in three NHS (National Health Service) supervised injecting clinics in London, Brighton and Darlington (England). During weeks 14-26, 50% or more tested negative for street heroin on weekly random urine analysis.

The researchers found that at 26 weeks:

• 80% of patients remained in assigned treatment:
  
  
  • 81% on supervised injectable methadone
  • 88% on supervised injectable heroin
  • 69% on optimized oral methadone
• Proportions of patients achieving 50% or more negative samples for street heroin were:
  
  
  • 66% for the injectable heroin group
  • 30% for the injectable methadone group
  • 19% for the oral methadone group

The measure of measurable improvement, the pre-selected primary outcome, was that through Months 4-6, at least 50% of randomly collected urines tested negative for street heroin (from weekly random urine analysis). The authors also report on 'abstinence from street heroin', and a similar greater benefit of the supervised heroin treatment was observed, compared with injectable or oral methadone.

The authors said:

We have shown that treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone. Furthermore, this difference was evident within the first 6 weeks of treatment.

Rolling out the prescription of injectable heroin and methadone to clients who do not respond to other forms of treatment', is detailed in the UK Government's 2008 Drug Strategy, subject to the results from this trial. In the past 15 years, six randomised trials have all reported benefits from treatment with injectable heroin compared with oral methadone. Supervised injectable heroin should now be provided, with close monitoring, for carefully selected chronic heroin addicts in the UK

Professor Strang, team leader, said:

"Our scientific understanding about how to treat people with severe heroin addiction has taken an important step forward. The RIOTT study shows that previously unresponsive patients can achieve major reductions in their use of street heroin and, impressively, these outcomes were seen within 6 weeks. Our work offers government robust evidence to support the expansion of this treatment, so that more patients can benefit.

"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"
Prof John Strang MD, Nicola Metrebian PhD, Nicholas Lintzeris PhD, Laura Potts MSc, Tom Carnwath MRCPsych, Soraya Mayet MRCPsych, Hugh Williams MRCPsych, Deborah Zador MD, Richard Evers MSc, Teodora Groshkova PhD, Vikki Charles MA, Anthea Martin BSc, Luciana Forzisi DClinPsych
The Lancet, Volume 375, Issue 9729, Pages 1885 - 1895, 29 May 2010
doi:10.1016/S0140-6736(10)60349-2

Comment - "Science and politics of heroin prescription"
Thomas Ker, Julio SG Montaner, Evan Wood
The Lancet, Volume 375, Issue 9729, Pages 1849 - 1850, 29 May 2010
doi:10.1016/S0140-6736(10)60544-2

Podcast

Written by: Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

• Additional
• References
• Citations