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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.
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.
Uniquely among modern heroin prescribing trials, the trial in Germany was not confined to heroin-addicted patients who had done poorly on methadone, offering the opportunity to assess whether heroin should be reserved for these patients. The conclusion was that other patients too benefit more from injectable heroin than oral methadone.
STUDY 2010 HTM file
The Andalusian trial on heroin-assisted treatment: a 2 year follow-up
Heroin/cocaine addicts in Granada in Spain who were being prescribed heroin made greater sustained improvements in their illicit heroin use, crime and psychological health and showed signs of more social reintegration than patients who nearly three years before had been randomly allocated to methadone.
In Germany, heroin-addicted patients suffering from mental disorders benefited more from being prescribed heroin than methadone and did so to almost the same degree as other patients, including greater remission in psychiatric symptoms.
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 given (as there usually will be) small numbers, experience in London was that not much changed.
STUDY 2010 HTM file
A survey of community drug team prescribing policies and client views
Contrary to national guidelines, in the mid-2000s in England and Wales, prescribed doses of the heroin substitute methadone were generally low, and often even new patients were not required to take it under supervision at the pharmacy. Patients in Essex also generally favoured low doses and opposed supervised consumption.
This wide-ranging review uniquely draws together findings from authoritative reviews of rigorous research conducted for the Cochrane collaboration and later studies concerned with the pharmacological and psychosocial treatment of dependence on opiate-type drugs like heroin, concluding that retention is the common key to success.
From Canada the first study to show that among long-term, severely opiate dependent patients who have not responded well to prior treatment, women as well as men benefit more from being prescribed injectable heroin than oral methadone.
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