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


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.


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


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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  • Sources of funding Community Fund (Big Lottery) Research Section, through Action on Addiction, Hedley Foundation, UK National Health Service Research and Development support and the UK National Treatment Agency for Substance Misuse for the Department of Health and Home Office.


  • Competing interests JR received financial support from the producer of medical heroin in Switzerland for two publications.

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