BMJ  2004;328:228-229 (24 January), doi:10.1136/bmj.328.7433.228-c

Letter

Prescription of heroin to treatment resistant heroin addicts

Dutch heroin trials show retention is better with methadone alone

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

EDITOR—The conclusion by van den Brink et al that medical co-prescription of heroin to treatment resistant heroin addicts was more effective than methadone alone is not supported by all of their data.¹ Rather, the better quality retention data significantly favour the methadone only group.

The trialists' claim that heroin co-prescription is superior to routine methadone maintenance is based on a higher proportion of subjects showing overall improvement on a dichotomous, multi-domain outcome index.¹ However, the measures making up the index were based on self reports and likely to be biased in favour of the heroin groups because the study was not blinded and subjects given heroin were transferred to special, new clinics. The performance ratings are more a measure of the heroin subjects' enthusiasm for the new treatment centres and the legal use of heroin.

The trialists present separate sets of retention data for subjects who injected and . . . [Full text of this article]

Clinical Epidemiology, School of Public Health, A27 University of Sydney, Sydney, NSW 2006, Australia johnc@health.usyd.edu.au

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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]