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Heroin maintenance for chronic heroin dependents
M Ferri1, M Davoli, C A Perucci
1Cochrane Drugs and Alcohol Group, Department of Epidemiology ASL RME, Via di Santa Costanza, 53, Roma, Italy, 00198.
The Cochrane Database of Systematic Reviews
|October 30, 2003
Summary
Heroin maintenance treatment shows mixed results compared to methadone for opioid dependence. While some studies suggest benefits in reducing criminal activity and illicit use, definitive conclusions are limited by study heterogeneity.
Area of Science:
- Addiction medicine
- Pharmacological interventions
- Public health
Background:
- Opioid dependence is a chronic relapsing condition characterized by continued use despite adverse consequences.
- Maintenance treatment aims to stabilize patients through pharmacological administration, with options including Methadone, Buprenorphine, and LAAM.
- This review specifically examines heroin maintenance treatment for opioid dependence.
Purpose of the Study:
- To evaluate the efficacy and acceptability of heroin maintenance therapy compared to methadone or other substitution treatments.
- Key outcomes include patient retention, reduction in illicit substance use, and improvements in health and social functioning.
Main Methods:
- A systematic review of randomized controlled trials comparing heroin (alone or with methadone) maintenance to other pharmacological treatments.
- Searches included Cochrane CENTRAL, MEDLINE, EMBASE, and CINAHL up to 2002, with no language or publication year restrictions.
- Studies were independently assessed for inclusion and quality; data were extracted and double-checked, but a meta-analysis was not performed due to heterogeneity.
Main Results:
- Four studies with 577 patients met the inclusion criteria, exhibiting significant heterogeneity.
- Retention rates showed no statistical difference in two studies, favored heroin in one (RR=2.49), and favored methadone in another (RR=0.79).
- Heroin prescription showed potential in reducing criminal offenses (RR=0.32) and illicit heroin use (RR=0.33 in one study), with some studies indicating improved social functioning with combined heroin and methadone treatment.
Conclusions:
- Definitive conclusions on the overall effectiveness of heroin prescription are hindered by the non-comparability of available studies.
- Favorable results for heroin treatment emerged from studies in contexts with comprehensive and accessible Methadone Maintenance Treatment, often in patients who had previously failed methadone.
- Further research is needed to clarify the role and effectiveness of heroin maintenance therapy in opioid dependence treatment.