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Physical and mental health in severe opioid‐dependent patients within a randomized controlled maintenance treatment trial
Author(s) -
Reimer Jens,
Verthein Uwe,
Karow Anne,
Schäfer Ingo,
Naber Dieter,
Haasen Christian
Publication year - 2011
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/j.1360-0443.2011.03463.x
Subject(s) - medicine , heroin , methadone , adverse effect , randomized controlled trial , methadone maintenance , opiate , psychiatry , drug , receptor
Aims To evaluate physical and mental health and compare treatment outcomes in opiate‐dependent patients substituted either with heroin or methadone. Design Twelve‐month open‐label randomized controlled trial. Setting Out‐patient substitution clinics in seven German cities. Participants A total of 1015 opiate‐dependent individuals. Measurements Opiate Treatment Index–Health Scale Score (OTI), Body Mass Index (BMI), serology for infectious diseases such as hepatitis B, C and human immunodeficiency virus as well as tuberculosis, Karnofsky Performance Scale (KPS), electrocardiogram (ECG), echocardiogram, Symptom Checklist 90‐R (SCL‐90‐R), Global Assessment of Functioning (GAF), Modular System for Quality of Life and study medication‐related serious adverse events (SAE). Findings Improvements were found in both heroin and methadone substituted patients regarding OTI, BMI, KPS, SCL‐90‐R, and GAF, but they were more pronounced for the heroin group (analysis of variance, all P = 0.000). The frequency of pathological echocardiograms decreased in the heroin group and increased in the methadone group (χ 2 test, <0.05). Markers for infectious diseases and frequencies of pathological ECGs did not differ between baseline and 12 months, or between treatment groups. Study medication‐related serious adverse events, all of which were treated successfully, occurred 2.5 times more often in the heroin group. The majority of heroin‐related SAEs (41 of 58) occurred within a few minutes of the injections. Conclusions The integration of severe injection drug users either in methadone or heroin‐assisted maintenance treatment has positive effects on most physical and mental change‐sensitive variables, with heroin showing superior results. Due to medication‐related adverse events, patients should be observed for 15 minutes after a heroin injection.