Heroin-assisted treatment has been found to be effective for people with severe opioid dependence who are not interested in or do poorly on methadone maintenance.

To study heroin-assisted treatment in people on methadone who continue intravenous heroin and in those who are heroin dependent but currently not in treatment.

In an open-label multicentre randomised controlled trial, 1015 people with heroin dependence received a variable dose of injectable heroin (n=515) or oral methadone (n=500) for 12 months. Two response criteria, improvement of physical and/or mental health and decrease in illicit drug use, were evaluated in an intent-to-treat analysis.

Retention was higher in the heroin (67.2%) than in the methadone group (40.0%) and the heroin group showed a significantly greater response on both primary outcome measures. More serious adverse events were found in the heroin group, and were mainly associated with intravenous use.

Conclusions Heroin-assisted treatment is more effective for people with opioid dependence who continue intravenous heroin while on methadone maintenance or who are not enrolled in treatment. Despite a higher risk, it should be considered for treatment resistance under medical supervision.

Christian Haasen, MD, Uwe Verthein, PhD and Peter Degkwitz, PhD
Centre for Interdisciplinary Addiction Research, University Medical Centre Eppendorf, Hamburg

Juergen Berger, PhD
Institute for Medical Biometrics and Epidemiology, University Medical Centre Eppendorf, Hamburg

Michael Krausz, MD and Dieter Naber, MD
Centre for Interdisciplinary Addiction Research, University Medical Centre, Eppendorf, Hamburg, Germany

Correspondence: Dr Christian Haasen, Centre for Interdisciplinary Addiction Research, Department of Psychiatry, University Medical Centre Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Email: .(JavaScript must be enabled to view this email address)

The British Journal of Psychiatry (2007) 191: 55-62. doi: 10.1192/bjp.bp.106.026112

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