Related Experiment Videos
Heroin maintenance for chronic heroin dependents
M Ferri1, M Davoli, C A Perucci
1Project Unit: EBM and Models of Health Assistance, Agency of Public Health, Via di Santa Costanza 53, Rome, Italy, 00198. ferri@asplazio.it
The Cochrane Database of Systematic Reviews
|April 23, 2005
Summary
Heroin prescription may improve treatment retention and reduce criminal activity for some opioid dependence patients. However, definitive conclusions on effectiveness are limited due to study heterogeneity and specific patient populations.
Area of Science:
- Addiction Medicine
- Pharmacological Interventions
- Public Health
Background:
- Established medications for stabilizing heroin users include methadone, buprenorphine, and LAAM.
- This review specifically examines heroin prescription for heroin dependents.
Purpose of the Study:
- To assess heroin maintenance efficacy and acceptability against methadone or other substitution treatments.
- Key outcomes include treatment retention, reduced illicit substance use, and improved health/social functioning.
Main Methods:
- Systematic review of randomized controlled trials comparing heroin (alone or with methadone) to other pharmacological treatments.
- Searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL) without language or publication year restrictions.
- Independent assessment of trial inclusion and quality, with data extracted and double-checked.
Main Results:
- Four studies with 577 patients met inclusion criteria; heterogeneity precluded cumulative analysis.
- Conflicting results on treatment retention: one study favored heroin (RR 2.82), another favored methadone (RR 0.79).
- Heroin prescription showed potential in reducing criminal offenses (RR 0.32) and some improvements in social functioning when combined with methadone.
Conclusions:
- No definitive conclusions on the overall effectiveness of heroin prescription can be drawn.
- Positive results for heroin treatment emerged from studies in settings with accessible methadone maintenance, often for patients who failed prior treatments.
- Results from ongoing trials will be integrated as they become available.