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Effects Of Medical Heroin Co-prescription For Treatment-refractory Chronic Addicts

Quality level: 2

Process evaluation

Results

Not determined yet

Outcome evaluation

Results

Heroin co-prescription is more effective than methadone alone, irrespective of route of administration, analysis, outcome parameter 12 month after randomisation (response on a multidomain outcome index, sustained response on this index and no longer meeting inclusion thresholds for the trial), and study setting. Effectiveness was defined as at least 40% improvement compared to baseline assessments in at least one of the outcome domains without at the same time an equal percentage of deterioration at one or more of the other outcome domains (specifications are reported). The outcome domains were physical health, mental status, social functioning, substance use en general. The index effect size amounted to 25% higher for the co-prescription groups of injectors (Odds Ratio = 2,99) and to 23% among inhalers (Odds Ratio = 2,77). No significant effect size differences were observed between 10 and 12 months after the randomisation, indicating the absence of anticipation effects in the experimental condition (knowing that after a successful treatment effect co-prescription would be continued). For injectors and inhalers treatment effects and successful treatment outcomes occur within the first two months of treatment. Injectors responded faster (a maximum success rate within two months) and inhalers improved during the full 12-month period. The majority (81-87%) of the treatment responders in the experimental condition deteriorated substantially following discontinuation of the heroin prescription ( two months after discontinuation mean outcome scores had returned to equal dysfunctional levels measured just before the start of the experiment). Thus benefits are linked to continuation of treatment. Furthermore, co-prescription appears to be practicable and safe with no excess of serious medical adverse effects and with a limited number of controllable public order problems.


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References

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The PDF contains the full intervention description including additional contact information.

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Page last updated: Friday, 20 January 2012