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Supervised injectable heroin better at reducing street heroin use than supervised injectable methadone or optimised oral methadone

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Question

Question

How effective is supervised injectable treatment with medicinal heroin or methadone compared with optimised oral methadone for people with chronic heroin addiction?

Patients

127 people (aged 18–65 years) with chronic heroin addiction (mean length of opiate use: 16.6 years (SD 7.0)), receiving continuous treatment with oral methadone for at least 6 months at supervised clinics and regularly injecting street heroin (50% or more days in preceding 3 months). Main exclusions include regular heroin use for <3 years; unable to attend clinics; not resident in catchment area; co-morbid alcohol dependence; other severe medical or psychiatric disorders; and unstable use of prescription drugs.

Setting

Supervised injecting clinics in London, Darlington and Brighton, UK.

Intervention

Optimised oral methadone was compared with supervised injectable heroin and supervised injectable methadone. Oral methadone: single dose (≥80 mg/day) under supervision on 5 or more days/week for a minimum of 3 months alongside psychosocial support (‘takeaway’ methadone provided on weekends and supervision reduced if clinically appropriate); supervised injectable heroin self-administered in two equal doses (individually determined, maximum 900 mg/day, …

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