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A Procedure to Study the Effect of Prolonged Food Restriction on Heroin Seeking in Abstinent Rats
Published on: November 11, 2013
Heroin maintenance for chronic heroin-dependent individuals
Marica Ferri1, Marina Davoli, Carlo A Perucci
1Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction, Cais do Sodre' 1249-289 Lisbon, Lisbon, Portugal.
The Cochrane Database of Systematic Reviews
|December 14, 2011
Summary
Heroin prescription, when combined with methadone, improves treatment retention and reduces illicit drug use among opioid-dependent individuals. However, it carries a higher risk of adverse events, making it suitable for treatment-refractory patients under strict clinical supervision.
Area of Science:
- Pharmacology and Addiction Medicine
- Clinical Trials and Evidence Synthesis
- Public Health and Harm Reduction
Background:
- Established medications for opioid dependence include methadone, buprenorphine, and levo-alpha-acetyl-methadol (LAAM).
- This review specifically examines the efficacy and safety of prescribed heroin as a maintenance treatment for heroin dependence.
Purpose of the Study:
- To compare heroin maintenance therapy with methadone or other substitution treatments for opioid dependence.
- Key outcomes assessed include treatment efficacy, patient retention, reduction in illicit substance use, and improvements in health and social functioning.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Cochrane Register, MEDLINE, EMBASE, CINAHL) up to 2005, supplemented by personal communications.
- Included were randomized controlled trials comparing heroin maintenance treatment (alone or with methadone) against other pharmacological treatments for heroin dependence.
- Trial quality and data extraction were performed independently by two reviewers.
Main Results:
- Eight studies with 2007 patients met the inclusion criteria.
- Supervised injected heroin combined with flexible-dose methadone significantly improved patient retention in treatment and reduced illicit drug use compared to oral methadone alone.
- While not statistically significant, heroin maintenance showed a trend towards reduced mortality but was associated with a higher risk of adverse events. Evidence suggests reduced criminal activity and improved social functioning with heroin provision.
Conclusions:
- Prescribed heroin alongside flexible-dose methadone offers added benefits for long-term, treatment-refractory opioid users, including decreased illicit substance use, reduced criminal activity, and better treatment retention.
- A possible reduction in mortality was observed, though higher rates of serious adverse events necessitate careful patient selection.
- Heroin prescription should be reserved for individuals who have not responded to previous maintenance treatments and must be administered in clinical settings with robust follow-up.
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