Diacetylmorphine versus Methadone for the Treatment of Opioid Addiction
Top Cited Papers
- 20 August 2009
- journal article
- research article
- Published by Massachusetts Medical Society in New England Journal of Medicine
- Vol. 361 (8), 777-786
- https://doi.org/10.1056/nejmoa0810635
Abstract
Studies in Europe have suggested that injectable diacetylmorphine, the active ingredient in heroin, can be an effective adjunctive treatment for chronic, relapsing opioid dependence. In an open-label, phase 3, randomized, controlled trial in Canada, we compared injectable diacetylmorphine with oral methadone maintenance therapy in patients with opioid dependence that was refractory to treatment. Long-term users of injectable heroin who had not benefited from at least two previous attempts at treatment for addiction (including at least one methadone treatment) were randomly assigned to receive methadone (111 patients) or diacetylmorphine (115 patients). The primary outcomes, assessed at 12 months, were retention in addiction treatment or drug-free status and a reduction in illicit-drug use or other illegal activity according to the European Addiction Severity Index. The primary outcomes were determined in 95.2% of the participants. On the basis of an intention-to-treat analysis, the rate of retention in addiction treatment in the diacetylmorphine group was 87.8%, as compared with 54.1% in the methadone group (rate ratio for retention, 1.62; 95% confidence interval [CI], 1.35 to 1.95; P<0.001). The reduction in rates of illicit-drug use or other illegal activity was 67.0% in the diacetylmorphine group and 47.7% in the methadone group (rate ratio, 1.40; 95% CI, 1.11 to 1.77; P=0.004). The most common serious adverse events associated with diacetylmorphine injections were overdoses (in 10 patients) and seizures (in 6 patients). Injectable diacetylmorphine was more effective than oral methadone. Because of a risk of overdoses and seizures, diacetylmorphine maintenance therapy should be delivered in settings where prompt medical intervention is available. (ClinicalTrials.gov number, NCT00175357.)This publication has 20 references indexed in Scilit:
- Heroin-assisted treatment for opioid dependenceThe British Journal of Psychiatry, 2007
- Controlled trial of prescribed heroin in the treatment of opioid addictionJournal of Substance Abuse Treatment, 2006
- The Addiction Severity Index at 25: Origins, Contributions and TransitionsThe American Journal on Addictions, 2006
- Prediction of relapse to frequent heroin use and the role of methadone prescription: An analysis of the Amsterdam Cohort Study among drug usersDrug and Alcohol Dependence, 2005
- Substitution treatment of injecting opioid users for prevention of HIV infectionPublished by Wiley ,2004
- Drug AddictionNew England Journal of Medicine, 2003
- Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trialsBMJ, 2003
- Methadone maintenance therapy versus no opioid replacement therapy for opioid dependencePublished by Wiley ,2003
- New aspects in the treatment of heroin dependence with special reference to neurobiological aspectsEuropean Psychiatry, 2002
- EuropASI: European Adaptation of a Multidimensional Assessment Instrument for Drug and Alcohol DependenceEuropean Addiction Research, 1995