Heroin-assisted treatment for opioid dependence

TLDR

Heroin-assisted treatment is effective for severe opioid dependence when methadone maintenance fails or is not desired. The study aimed to evaluate heroin-assisted treatment in methadone users who still inject heroin and in untreated heroin-dependent individuals. An open-label multicentre RCT randomized 1,015 heroin-dependent participants to 12 months of variable-dose injectable heroin or oral methadone, assessing health improvement and reduced illicit drug use. Heroin-assisted treatment yielded higher retention (67.2% vs 40%) and superior health and drug-use outcomes, though it carried more serious adverse events linked to intravenous use, indicating it is more effective for treatment-resistant opioid dependence under medical supervision.

Abstract

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. 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. 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. 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. 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.