Published 6 November 2009, doi:10.1136/bmj.b4545
Cite this as: BMJ 2009;339:b4545

Editorials

Heroin assisted treatment

Should be a routine last resort in patients with opioid dependence refractory to standard treatments

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

In September 2009, preliminary results were reported from the British Randomised Injectable Opiate Treatment Trial (RIOTT) on supervised heroin assisted treatment for patients who are dependent on heroin but do not respond to conventional methadone substitution treatment.¹ One hundred and twenty seven patients were randomised to six months of supervised injectable heroin, supervised injectable methadone, or optimised oral methadone. Improvement was seen in the primary outcome measure of reduced use or abstinence from "street" heroin in all treatment groups, but the greatest effect was seen in people who received supervised injectable heroin—three quarters remained abstinent from illegal heroin, and number of days with criminal activities dropped from an average of 25 to eight days a month.

What other evidence is there on the effectiveness of heroin assisted treatment? Supervised heroin assisted treatment started in the early 1990s in Switzerland, where a large cohort study (n=1969) showed that it was a . . . [Full text of this article]

¹ Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands, PO Box 22660, 1100 DD Amsterdam, Netherlands

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I predict a RIOTT - but will it change policy?

Euan M Lawson, et al.
bmj.com, 6 Nov 2009 [Full text]

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