BMJ  2004;328:228 (24 January), doi:10.1136/bmj.328.7433.228

Letter

Prescription of heroin to treatment resistant heroin addicts

Double blinding is not possible

The first 150 words of the full text of this article appear below.

EDITOR—As mentioned in the discussion of the paper by van den Brink et al,¹ experiments with heroin maintenance cannot be double blind. This problem is much more serious than the authors acknowledge, particularly because considerable sanctions were connected to the participants' responses.

The participants in the control groups knew that the promise of heroin maintenance later on could be withdrawn if they improved during the control period without heroin on prescription. Moreover, the participants in the experimental groups knew that they could be expelled from the experiment if they deteriorated while receiving heroin. Finally, the participants who improved while receiving heroin were aware that they would have a fair chance of continued heroin on prescription provided that they deteriorated in an interim period without heroin provision. Even if improvement could have been measured fully unobtrusively rather than with self reports, this would have created serious problems.

However, it . . . [Full text of this article]

University of Groningen, 9712 TS Groningen, Netherlands t.dehue@ppsw.rug.nl

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

Wim van den Brink, Vincent M Hendriks, Peter Blanken, Maarten W J Koeter, Barbara J van Zwieten, and Jan M van Ree
BMJ 2003 327: 310. [Abstract] [Full Text] [PDF]