BMJ 1998;317:13-18 ( 4 July )

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

Thomas V Perneger, medical epidemiologist, a Francisco Giner, resident, b Miguel del Rio, fellow, b Annie Mino, head of division. b

a Institute of Social and Preventive Medicine, University of Geneva Medical School, CH-1211 Geneva 4, Switzerland, b Division of Substance Abuse, Department of Psychiatry, University Hospitals of Geneva, CH-1211 Geneva 14

Correspondence to: Dr Perneger perneger{at}cmu.unige.ch

Objective: To evaluate an experimental heroin maintenance programme.
Design: Randomised trial.
Setting: Outpatient clinic in Geneva, Switzerland.
Subjects: Heroin addicts recruited from the community who were socially marginalised and in poor health and had failed in at least two previous drug treatments.
Intervention: Patients in the experimental programme (n=27) received intravenous heroin and other health and psychosocial services. Control patients (n=24) received any other conventional drug treatment (usually methadone maintenance).
Main outcome measures: Self reported drug use, health status (SF-36), and social functioning.
Results: 25 experimental patients completed 6 months in the programme, receiving a median of 480 mg of heroin daily. One experimental subject and 10 control subjects still used street heroin daily at follow up (difference 44%; 95% confidence interval 16% to 71%). Health status scores that improved significantly more in experimental subjects were mental health (0.58 SD; 0.07 to 1.10), role limitations due to emotional problems (0.95 SD; 0.11 to 1.79), and social functioning (0.65 SD; 0.03 to 1.26). Experimental subjects also significantly reduced their illegal income and drug expenses and committed fewer drug and property related offences. There were no benefits in terms of work, housing situation, somatic health status, and use of other drugs. Unexpectedly, only nine (38%) control subjects entered the heroin maintenance programme at follow up.
Conclusions: A heroin maintenance programme is a feasible and clinically effective treatment for heroin users who fail in conventional drug treatment programmes. Even in this population, however, another attempt at methadone maintenance may be successful and help the patient to stop using injectable opioids.

Key messages

  • A heroin maintenance programme may be a useful treatment option for patients who do not succeed in conventional drug treatment programmes

  • Patients randomly allocated to the Geneva heroin maintenance programme fared better that patients in conventional drug treatments in terms of street drug use, mental health, social functioning, and illegal activities

  • Results of the trial apply only to a subgroup of severely addicted people who failed repeatedly in conventional drug treatments

  • This evaluation does not distinguish between the effects of heroin itself and the effects of other medical and psychosocial services that were provided as part of the programme

  • There was less demand for the heroin maintenance programme than anticipated and most control subjects declined entry into the programme at the end of the study



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