Abstinence Is More Common among Patients Who Use Heroin or Crack Cocaine Alone Compared with Those Who Use Both

Crack cocaine use can be difficult to treat and is a common comorbid condition among heroin-dependent individuals. Since 2007, the National Health Service in England has tracked past-month drug use among patients with heroin and/or crack-cocaine dependence admitted to treatment. Patients report heroin and/or crack cocaine use at admission, every 6 months, and at discharge. Researchers reviewed self-reported drug use among 14,656 such patients to determine whether heroin and crack-cocaine use decreased during treatment and to assess whether use of both drugs at admission was associated with lower abstinence. The mean time from admission to review was 19 weeks.

• People who used only heroin reduced their average use from 23 of 28 days at admission to 7 of 28 days at review. Forty-two percent achieved abstinence.

• People who used only crack cocaine reduced their average use from 13 of 28 days at admission to 5 of 28 days at review. Fifty-seven percent achieved abstinence.

• People who used both heroin and crack cocaine reduced their heroin use from 23 of 28 days at admission to 9 of 28 days at review, and their cocaine use from 13 of 28 days at admission to 5 of 28 days at review. Thirty-three percent achieved abstinence from heroin, and 51% achieved abstinence from cocaine.

Comments:

This large cohort study demonstrated substantial in-treatment reductions in both heroin and crack-cocaine use within 6 months of entering treatment. Abstinence rates were higher among people using either heroin or crack cocaine alone. Although people with both heroin and crack-cocaine use also benefit from treatment, these results indicate they are less likely to achieve abstinence and may require additional treatment.

Alexander Y. Walley, MD, MSc

Reference:

Marsden J, Eastwood B, Bradbury C, et al. Effectiveness of community treatments for heroin and crack cocaine addiction in England: a prospective, in-treatment cohort study. Lancet. 2009;374(9697):1262–1270.