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Clinical Trial
. 2003 Aug 9;327(7410):310.
doi: 10.1136/bmj.327.7410.310.

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

Wim van den Brink  1 , Vincent M Hendriks, Peter Blanken, Maarten W J Koeter, Barbara J van Zwieten, Jan M van Ree
Affiliations
Clinical Trial

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

Wim van den Brink et al. BMJ. .

Erratum in

  • BMJ. 2003 Sep 27;3217(7417):724

Abstract

Objective: To determine whether supervised medical prescription of heroin can successfully treat addicts who do not sufficiently benefit from methadone maintenance treatment.

Design: Two open label randomised controlled trials.

Setting: Methadone maintenance programmes in six cities in the Netherlands.

Participants: 549 heroin addicts.

Interventions: Inhalable heroin (n = 375) or injectable heroin (n = 174) prescribed over 12 months. Heroin (maximum 1000 mg per day) plus methadone (maximum 150 mg per day) compared with methadone alone (maximum 150 mg per day). Psychosocial treatment was offered throughout.

Main outcome measures: Dichotomous, multidomain response index, including validated indicators of physical health, mental status, and social functioning.

Results: Adherence was excellent with 12 month outcome data available for 94% of the randomised participants. With intention to treat analysis, 12 month treatment with heroin plus methadone was significantly more effective than treatment with methadone alone in the trial of inhalable heroin (response rate 49.7% v 26.9%; difference 22.8%, 95% confidence interval 11.0% to 34.6%) and in the trial of injectable heroin (55.5% v 31.2%; difference 24.3%, 9.6% to 39.0%). Discontinuation of the coprescribed heroin resulted in a rapid deterioration in 82% (94/115) of those who responded to the coprescribed heroin. The incidence of serious adverse events was similar across treatment conditions.

Conclusions: 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.

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Figures

Fig 1
Fig 1
Progress of participants through stages of trials (A=control group—methadone only; B=experimental group—methadone plus heroin; C=comparison group—methadone alone then methadone plus heroin)
Fig 2
Fig 2
Sustained response to treatment during 12 months of trials of prescribed heroin (inhaling and injecting)
See this image and copyright information in PMC

Comment in

References

    1. Van den Brink W, Hendriks VM, Van Ree J. Medical co-prescription of heroin to chronic, treatment-resistant methadone patients in the Netherlands. J Drug Issues 1999;29: 587-608.
    1. Nationale Drug Monitor (NDM). Jaarbericht NDM 2001. Utrecht: Bureau NDM, 2001.
    1. Driessen FMHM. Methadonverstrekking in Nederland. Utrecht: Bureau Driessen, 1990.
    1. Driessen FMHM. Methadoncliënten in Nederland. Utrecht: Bureau Driessen, 1992.
    1. Driessen FMHM, Völker BGM, Kregting J, Van der Lelij B. De ontwikkeling van de situatie van methadoncliënten gedurende twee jaar. Utrecht: Bureau Driessen, 1999.

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