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Heroin maintenance for persons with chronic heroin dependence

Author: Therese Kristine Dalsbø; Asbjørn Steiro; Karianne Thune Hammerstrøm; Geir Smedslund; Nasjonalt kunnskapssenter for helsetjenesten,
Publisher: Oslo : Norwegian Knowledge Centre for the Health Services, July 2010.
Series: Online access: NCBI NCBI Bookshelf.
Edition/Format:   eBook : Document : EnglishView all editions and formats
Summary:
Background This report addresses the following research question: Are there differences in effect between heroin assisted maintenance (diacetylmorphine) versus the traditional substitution maintenance treatment (methadone, buprenorphine) for persons with chronic heroin dependence? Methods We based our systematic review on a literature search in relevant databases for previous systematic reviews of high quality and  Read more...
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Material Type: Document, Internet resource
Document Type: Internet Resource, Computer File
All Authors / Contributors: Therese Kristine Dalsbø; Asbjørn Steiro; Karianne Thune Hammerstrøm; Geir Smedslund; Nasjonalt kunnskapssenter for helsetjenesten,
OCLC Number: 1048159052
Notes: English summary excerpted from full report in Norwegian: Heroinassistert substitusjonsbehandling for personer med kronisk heroinavhengighet.
Excerpt from report no. 17-2010.
Description: 1 online resource (1 PDF file (pages 52-55))
Series Title: Online access: NCBI NCBI Bookshelf.
Responsibility: Therese Kristine Dalsbø, Asbjørn Kulseng Steiro, Karianne Thune Hammerstrøm, Geir Smedslund.

Abstract:

Background This report addresses the following research question: Are there differences in effect between heroin assisted maintenance (diacetylmorphine) versus the traditional substitution maintenance treatment (methadone, buprenorphine) for persons with chronic heroin dependence? Methods We based our systematic review on a literature search in relevant databases for previous systematic reviews of high quality and randomised controlled trials. We synthesised and critically appraised the included documentation after they met our pre-defined inclusion criteria. We extracted results from the following outcomes: mortality, retention in treatment, use of illegal drugs, quality of life and serious adverse outcomes. Results We included eight randomised controlled trials. The oldest study was published in 1990 and the most recent was from 2010. Two of the studies were performed in the Netherlands, two from England, and one each from Switzerland, Spain, Germany and Canada. In one of the trials the participants were heroin smokers whereas the other studies predominately concerned injecting heroin users. Participants in the studies were mainly adults (+35 years) and had a history of chronic, long term heroin addiction, and many had previously failed attempts in traditional treatment programs (without and with methadone substitution and maintenance). All studies reported outcomes for mortality and retention in treatment. Whilst for the other outcomes only five and six of the studies presented effect sizes. The results were not quantitatively combined due to heterogeneity. The quality for this documentation is graded. Grading the studies separately for a Norwegian audience led us to the category very low quality. The results must therefore be interpreted as uncertain. Conclusion The existing documentation does not give an adequate foundation to answer the question of effectiveness of heroin assisted maintenance treatment compared to traditional maintenance (with methadone) for persons with chronic heroin dependence for the outcomes mortality, retention in treatment, use of illegal drugs, severe adverse outcomes and quality of life. Even though the quality, from a Norwegian perspective, is graded to be very low, others can argue that the intervention is effective and promising for patients in other countries. We need research in Norway to answer the question of effectiveness for a Norwegian context.

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Methods We based our systematic review on a literature search in relevant databases for previous systematic reviews of high quality and randomised controlled trials. We synthesised and critically appraised the included documentation after they met our pre-defined inclusion criteria. We extracted results from the following outcomes: mortality, retention in treatment, use of illegal drugs, quality of life and serious adverse outcomes. Results We included eight randomised controlled trials. The oldest study was published in 1990 and the most recent was from 2010. Two of the studies were performed in the Netherlands, two from England, and one each from Switzerland, Spain, Germany and Canada. In one of the trials the participants were heroin smokers whereas the other studies predominately concerned injecting heroin users. Participants in the studies were mainly adults (+35 years) and had a history of chronic, long term heroin addiction, and many had previously failed attempts in traditional treatment programs (without and with methadone substitution and maintenance). All studies reported outcomes for mortality and retention in treatment. Whilst for the other outcomes only five and six of the studies presented effect sizes. The results were not quantitatively combined due to heterogeneity. The quality for this documentation is graded. Grading the studies separately for a Norwegian audience led us to the category very low quality. The results must therefore be interpreted as uncertain. Conclusion The existing documentation does not give an adequate foundation to answer the question of effectiveness of heroin assisted maintenance treatment compared to traditional maintenance (with methadone) for persons with chronic heroin dependence for the outcomes mortality, retention in treatment, use of illegal drugs, severe adverse outcomes and quality of life. Even though the quality, from a Norwegian perspective, is graded to be very low, others can argue that the intervention is effective and promising for patients in other countries. 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