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Previous Volume 361:777-786 August 20, 2009 Number 8 Next

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ABSTRACT

Background Studies in Europe have suggested that injectable diacetylmorphine, the active ingredient in heroin, can be an effective adjunctive treatment for chronic, relapsing opioid dependence.

Methods 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.

Results 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).

Conclusions 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 [ClinicalTrials.gov] .)

Source Information

From the School of Population and Public Health, University of British Columbia (E.O.-J., D.C.M., A.A., M.T.S.); the Centre for Health Evaluation and Outcome Sciences, Providence Health Care (E.O.-J., D.C.M., D.G., A.A., M.T.S.); and Vancouver Coastal Health (D.C.M.) — all in Vancouver, BC, Canada; and the Centre de Recherche de l'Université de Montréal (S.B., P.L.) and the Centre de Recherche et Aide aux Narcomanes (P.L.) — both in Montreal.

Address reprint requests to Dr. Schechter at the University of British Columbia School of Population and Public Health, 5804 Fairview Ave., Vancouver, BC V6T 1Z3, Canada, or at martin.schechter{at}ubc.ca.

Full Text of this Article

This article has been cited by other articles:

• (2009). All you need to read in the other general journals. BMJ 339: b3437-b3437 [Full Text]  
• Berridge, V. (2009). Heroin Prescription and History. NEJM 361: 820-821 [Full Text]  
• (2009). Heroin Injection vs. Methadone for Opioid Addiction. JWatch Psychiatry 2009: 1-1 [Full Text]