Heroin maintenance for chronic heroin dependents

Abstract

BackgroundMany medications have been used for stabilizing heroin users: Methadone, Buprenorphine and levo-alpha-acetyl-methadol (LAAM.) The present review focus on the prescription of heroin to heroin dependents. ObjectivesTo assess the efficacy and acceptability of heroin maintenance versus methadone or other substitution treatments for opioid dependence, in retaining patients in treatment; reducing the use of illicit substances and improving health and social functioning.

Heroin-assisted treatment for opioid dependence

“…This large multicentre study confirms the results of the Swiss (Rehm et al , 2001) and Dutch (van der Brink et al , 2003) studies and therefore addresses the limitations pointed out by the Cochrane review (Ferri et al , 2005) by providing strong further evidence of the efficacy of prescribed heroin in the treatment of people with opioid dependence who have not profited from other forms of treatment. Considering the higher rate of serious adverse events, heroin prescription should remain a treatment of last resort for people who are currently or have in the past failed at maintenance treatment.…”

Heroin-assisted treatment for opioid dependence

“…This large multicentre study confirms the results of the Swiss (Rehm et al , 2001) and Dutch (van der Brink et al , 2003) studies and therefore addresses the limitations pointed out by the Cochrane review (Ferri et al , 2005) by providing strong further evidence of the efficacy of prescribed heroin in the treatment of people with opioid dependence who have not profited from other forms of treatment. Considering the higher rate of serious adverse events, heroin prescription should remain a treatment of last resort for people who are currently or have in the past failed at maintenance treatment.…”

Heroin on trial: Systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction

“…It is appropriate to compare and contrast the conclusions from the above analyses with the conclusions from earlier and more recent Cochrane Reviews. 12,60 The original 2005 Cochrane Review 60 examined studies published up to 2002 (and with only two of the studies included in our analysis above) and concluded that, even though there were some results in favour of heroin treatment, ‘no definitive conclusions about the overall effectiveness of heroin prescription (was) possible’. By the time of the later Cochrane Review in 2011, all six of the above-randomised trials were included in the new Cochrane analysis, 12 and the Cochrane group concluded that, on the basis of the expanded current evidence, ‘heroin prescription should be indicated to people who (are) currently or have previously failed maintenance treatment, and it should be provided in clinical settings where proper follow-up is ensured’, while also noting that adverse events were consistently more frequent in the heroin groups.…”

“…Also, the latest 2011 Cochrane review 12 reaches a more positive conclusion on SIH than the original 2005 Cochrane review. 60 However, scientific questions still remain. The new empirical evidence from randomised trials on heroin treatment has mostly focused on short-term outcome, with the randomisation phase of treatment being a maximum of 12 months.…”

Perspectives on the Pharmacological Treatment of Heroin Addiction

“…The results confirmed that prescribed heroin was more effective than methadone maintenance alone. However, a Cochrane review 65 concluded that there was insufficient evidence to recommend treatment with pharmaceutical heroin at that time as the trials differed in too many aspects. However, subsequent studies in Spain, Germany, and Canada have not only confirmed the clinical effects to be superior to oral methadone treatment but also found a reduction in drug-related problems, HIV risk behavior, and illicit heroin use.…”

Heroin-assisted treatment for opioid dependence

“…This large multicentre study confirms the results of the Swiss (Rehm et al , 2001) and Dutch (van der Brink et al , 2003) studies and therefore addresses the limitations pointed out by the Cochrane review (Ferri et al , 2005) by providing strong further evidence of the efficacy of prescribed heroin in the treatment of people with opioid dependence who have not profited from other forms of treatment. Considering the higher rate of serious adverse events, heroin prescription should remain a treatment of last resort for people who are currently or have in the past failed at maintenance treatment.…”

Heroin on trial: Systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction

“…It is appropriate to compare and contrast the conclusions from the above analyses with the conclusions from earlier and more recent Cochrane Reviews. 12,60 The original 2005 Cochrane Review 60 examined studies published up to 2002 (and with only two of the studies included in our analysis above) and concluded that, even though there were some results in favour of heroin treatment, ‘no definitive conclusions about the overall effectiveness of heroin prescription (was) possible’. By the time of the later Cochrane Review in 2011, all six of the above-randomised trials were included in the new Cochrane analysis, 12 and the Cochrane group concluded that, on the basis of the expanded current evidence, ‘heroin prescription should be indicated to people who (are) currently or have previously failed maintenance treatment, and it should be provided in clinical settings where proper follow-up is ensured’, while also noting that adverse events were consistently more frequent in the heroin groups.…”

“…Also, the latest 2011 Cochrane review 12 reaches a more positive conclusion on SIH than the original 2005 Cochrane review. 60 However, scientific questions still remain. The new empirical evidence from randomised trials on heroin treatment has mostly focused on short-term outcome, with the randomisation phase of treatment being a maximum of 12 months.…”

Perspectives on the Pharmacological Treatment of Heroin Addiction

“…The results confirmed that prescribed heroin was more effective than methadone maintenance alone. However, a Cochrane review 65 concluded that there was insufficient evidence to recommend treatment with pharmaceutical heroin at that time as the trials differed in too many aspects. However, subsequent studies in Spain, Germany, and Canada have not only confirmed the clinical effects to be superior to oral methadone treatment but also found a reduction in drug-related problems, HIV risk behavior, and illicit heroin use.…”

Heroin-assisted treatment for opioid dependence

“…This large multicentre study confirms the results of the Swiss (Rehm et al , 2001) and Dutch (van der Brink et al , 2003) studies and therefore addresses the limitations pointed out by the Cochrane review (Ferri et al , 2005) by providing strong further evidence of the efficacy of prescribed heroin in the treatment of people with opioid dependence who have not profited from other forms of treatment. Considering the higher rate of serious adverse events, heroin prescription should remain a treatment of last resort for people who are currently or have in the past failed at maintenance treatment.…”

Heroin on trial: Systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction

“…It is appropriate to compare and contrast the conclusions from the above analyses with the conclusions from earlier and more recent Cochrane Reviews. 12,60 The original 2005 Cochrane Review 60 examined studies published up to 2002 (and with only two of the studies included in our analysis above) and concluded that, even though there were some results in favour of heroin treatment, ‘no definitive conclusions about the overall effectiveness of heroin prescription (was) possible’. By the time of the later Cochrane Review in 2011, all six of the above-randomised trials were included in the new Cochrane analysis, 12 and the Cochrane group concluded that, on the basis of the expanded current evidence, ‘heroin prescription should be indicated to people who (are) currently or have previously failed maintenance treatment, and it should be provided in clinical settings where proper follow-up is ensured’, while also noting that adverse events were consistently more frequent in the heroin groups.…”

“…Also, the latest 2011 Cochrane review 12 reaches a more positive conclusion on SIH than the original 2005 Cochrane review. 60 However, scientific questions still remain. The new empirical evidence from randomised trials on heroin treatment has mostly focused on short-term outcome, with the randomisation phase of treatment being a maximum of 12 months.…”

Perspectives on the Pharmacological Treatment of Heroin Addiction

“…The results confirmed that prescribed heroin was more effective than methadone maintenance alone. However, a Cochrane review 65 concluded that there was insufficient evidence to recommend treatment with pharmaceutical heroin at that time as the trials differed in too many aspects. However, subsequent studies in Spain, Germany, and Canada have not only confirmed the clinical effects to be superior to oral methadone treatment but also found a reduction in drug-related problems, HIV risk behavior, and illicit heroin use.…”