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Heroin assisted treatment

BMJ 2009; 339 doi: (Published 06 November 2009) Cite this as: BMJ 2009;339:b4545
  1. Wim van den Brink, professor of psychiatry and addiction
  1. 1Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands, PO Box 22660, 1100 DD Amsterdam, Netherlands
  1. W.vandenBrink{at}

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

    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 …

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