Heroin to Treat Opioid Dependence: A Randomized Trial
Although methadone maintenance is effective for opioid dependence, many people drop out of treatment or continue to use illicit drugs. In a Canadian study, 251 people with opioid dependence, 2 previous treatment episodes, and long-term opioid use (mostly heroin) were randomized to receive either oral methadone (n=111) or injectable heroin (diacetylmorphine, up to 3 injections daily) (n=115) for 1 year. The remaining 25 subjects were randomized to receive injectable hydromorphone to facilitate validation of self-reported heroin use by urine tests. All subjects received counseling and psychosocial services.
- Illegal heroin use decreased more in the heroin group than in the methadone group (from 27 days per month at baseline to 5 and 12 days per month, respectively).
- Retention in treatment was better in the heroin group than in the methadone group (88% versus 54%) as was the proportion of subjects with a 20% or greater reduction in illegal activities or drug use (67% versus 48%). The heroin group also had better social, employment, and psychiatric outcomes.
- The heroin group experienced 24 adverse events, including 11 overdoses and 7 seizures. The methadone group had none.
- Hydromorphone recipients could not tell whether they were taking hydrohydromorphone or heroin, and outcomes were similar to those in the heroin group.