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

Letter

Prescription of heroin to treatment resistant heroin addicts

Replacement therapies need to be tested on a level playing field

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

EDITOR—The study of medical prescription of heroin by van den Brink et al should be interpreted with caution.1

Firstly, the selection of opiate dependent patients with at least four weeks of continuous treatment in the past five years does not define resistance to treatment with methadone treatment, but rather, early treatment intervention. This may explain the substantial treatment response to longer term methadone in the control group, where the only intervention is randomisation into a controlled trial.

Secondly, in such a study taking methadone and heroin dosage levels into account is crucial when evaluating clinical outcome; adequate doses of opiate replacement are critical to treatment success.2 Actual doses are reported only in the electronic version of the paper and show that doses of combined heroin and methadone in the heroin treatment groups are about 20% higher in terms of methadone equivalents compared with the control methadone only treatment . . . [Full text of this article]

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Laurence J Reed, specialist registrar

spdpljr@iop.kcl.ac.uk, Bethlem Royal Hospital, South London and Maudsley NHS Trust, Beckenham, Kent BR3 3BX

Cornelis de Wet, specialist registrar, Jennifer Bearn, consultant

Bethlem Royal Hospital, South London and Maudsley NHS Trust, Beckenham, Kent BR3 3BX


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Relevant Article

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]

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