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Drug use, health and social outcomes of hard‐to‐treat heroin addicts receiving supervised injectable opiate treatment: secondary outcomes from the R andomized I njectable O pioid T reatment T rial ( RIOTT )
Author(s) -
Metrebian Nicola,
Groshkova Teodora,
Hellier Jennifer,
Charles Vikki,
Martin Anthea,
Forzisi Luciana,
Lintzeris Nicholas,
Zador Deborah,
Williams Hugh,
Carnwath Tom,
Mayet Soraya,
Strang John
Publication year - 2015
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12748
Subject(s) - medicine , heroin , randomized controlled trial , methadone , psychosocial , opiate , methadone maintenance , opiate substitution treatment , opioid , addiction , anesthesia , psychiatry , drug , buprenorphine , receptor
Aims The R andomized I njectable O pioid T reatment T rial ( RIOTT) compared supervised injectable heroin ( SIH ) and supervised injectable methadone ( SIM ) with optimized oral methadone ( OOM ) ( ISRCTN 0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH . We now examine secondary outcomes. Design Multi‐site randomized controlled trial ( RCT) comparing SIH versus OOM and SIM versus OOM . Setting Three supervised injectable opiate clinics in E ngland. Participants Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment ( n  = 127), randomized to either SIH ( n  = 43), SIM ( n  = 42) or OOM ( n  = 42). All received high levels of medical and psychosocial support. Measurements Secondary outcomes: wider drug use, crime, health and social functioning at 6 months. Findings A t 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health ( SF ‐36) or social functioning. Within each treatment group, significant reductions were observed in crime [ SIH  = odds ratio ( OR) 0.05; P  < 0.001; SIM  =  OR 0.11; P  = 0.002; OOM  =  OR 0.11; P  = 0.003] and money spent per week on illicit drugs ( SIH  = mean change £–289.43; P  < 0.001; SIM  = mean change £–183.41; P  < 0.001; OOM  = mean change £–162.80; P  < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £–92.04; P  < 0.001). Significant improvements were seen in physical health for SIH and SIM ( SIH  = mean change 3.97; P  = 0.008; SIM = mean change 4.73; P  = 0.002) and mental health for OOM (mean change 6.04; P  = 0.013). Conclusions Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6‐month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes.

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