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Opiate dependent patients in Scotland who opted for or were allocated to methadone sustained their abstinence from heroin as well as those on buprenorphine, but buprenorphine was far better at helping continuing heroin users cut back – suggestive, but the study’s constraints make the practice implications unclear.
STUDY 1999 PDF file 182Kb
Heroin prescribing can help methadone's failures
Studies in UK and Switzerland show that many opiate-dependent patients failed by oral methadone, or seeking treatment but unwilling to give up heroin, do better if prescribed heroin in terms of crime, illicit opiate use and psychological wellbeing.
STUDY 2001 PDF file 107Kb
Injectable methadone maintenance suitable for more severely affected heroin addicts
Conducted in London, the first study to randomise opiate dependent patients to injectable versus oral methadone maintenance suggested that the injectable option is preferable for addicts with relatively severe health and psychological problems.
REVIEW 2003 PDF file 925Kb
Controversial, expensive, yet promising so much, interest is increasing in prescribing heroin to heroin addicts. Just five studies hold what answers there are to whether this can work, including a probably unrepeatable early British study.
OFFCUT 2003 PDF file 147Kb
NTA guidance on heroin prescribing
Guidance from the English National Treatment Agency on the prescribing of injectable opioids for the treatment of heroin addiction based on the views of an expert group and a review of the literature.
DOCUMENT 2006 PDF file 1326Kb
The Rolleston legacy
In British drug policy no document has more claim to the term 'classic' than the 1926 Rolleston report, which enshrined doctors' freedom to prescribe opiates to opiate addicts.
STUDY 2010 HTM file
Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial
Controversial and expensive it might be, but in the first British randomised trial, a continental-style heroin prescribing programme featuring on-site supervised consumption suppressed illegal heroin use much more effectively than oral methadone.
REVIEW 2009 HTM file
Prescription of heroin for the management of heroin dependence: current status
Should heroin prescribing be a mass treatment entry route or a niche option for the few who have not done well in optimised (but still cheaper) mainstream treatments? With nearly all the latest studies to hand, this review came down firmly on the 'niche' side of the debate.
Addicts attending a clinic twice a day to take prescribed heroin seems like a recipe for an unwelcome increase in local drug-related disorder and nuisance, but in London the effect was to remove rather than add people to the troubling street-drinking population.
REVIEW 2011 HTM file
Heroin maintenance for chronic heroin-dependent individuals
Update of the first authoritative review to combine results from all trials to date of long-term heroin prescribing for the management of heroin addiction finds important advantages for seemingly intractable patients previously failed by methadone, including reduced illegal drug use.
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