Controlled trial of prescribed heroin in the treatment of opioid addiction

Benzodiazepine use among patients in heroin-assisted vs. methadone maintenance treatment: Findings of the German randomized controlled trial

“…Illicit benzodiazepine use should be seen in a broader context of polydrug use, where additional sedation of benzodiazepines may be wanted to balance out other effects of illicit drugs such as cocaine and street heroin. Therefore, the overall better effect of HAT in reducing illicit drug use (Haasen et al, 2007;March et al, 2006;van den Brink et al, 2003) may be associated with the reduction of benzodiazepine use. The stronger association of HAT and BZD decrease may also be explained in part by neurobiological aspects, which could also explain why BZD use is lower among heroin dependents not in maintenance treatment (Backmund et al, 2005).…”

“…Recently, it has been suggested that more difficult-to-treat patients may do better in maintenance treatment using diamorphine (heroin). Clinical studies in Switzerland (Perneger et al, 1998;Rehm et al, 2001), the Netherlands (Blanken et al, 2005;van den Brink et al, 2003), Spain (March et al, 2006), Germany (Haasen et al, 2007;Verthein et al, 2008) and Canada (Oviedo-Joekes et al, 2009) have found heroin-assisted treatment (HAT) to be more effective than MMT in the treatment of methadone nonresponders. However, these studies have not analyzed the effect of HAT compared to MMT on BZD use.…”

The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

“…Clinical trials and follow-up studies have demonstrated that prescribed heroin is safe, feasible, and effective. [31][32][33][34][35][36][37] In 2005, a randomized controlled trial with injectable heroin [denoted the North American Opiate Medication Initiative (NAOMI)] began in two Canadian cities (Vancouver and Montreal), aimed at evaluating the feasibility and effectiveness of HAT in the Canadian context. The objective of the present analysis is to describe the profile of the subjects recruited into NAOMI and to evaluate the comparability with international patient profiles of other studies of HAT.…”

Heroin-assisted Treatment (HAT) a Decade Later: A Brief Update on Science and Politics

“…The target group was regular opioid injectors with at least two previous MMT episodes and severe health or social problems. 26 The study found no differences in retention rates between experimental and control arm; it found significantly greater improvements for drug-related risk behaviors, illicit heroin use, and health indicators in the experimental group, although both the experimental and control group demonstrated significant intrinsic improvements on key outcome indicators over time. Trial participants continue to receive HAT, and new patients enter to fill out open HAT slots, under compassionate use principles and the umbrella of a follow-up study.…”

“…33,41 Second, the discussed studies above have demonstrated in several different contexts that the implementation of HAT is feasible, effective, and safe as a therapeutic intervention. 21,24,26,30 This should not be seen as a conclusion that could be taken for granted because many observers expected disastrous consequences from the provision of medical heroin prescription.…”