Prescribing Drug of Choice to Opiate Dependent Drug Users: A Comparison of Clients Receiving Heroin with Those Receiving Injectable Methadone at a West London Drug Clinic

• NCJ Number: 191826
• Journal: Drug and Alcohol Review Volume: 20 Issue: 3 Dated: September 2001 Pages: 267-276
• Author(s): Nicky Metrebian; William Shanahan; Gerry V. Stimson; Colin Small; Mark Lee; Victor Mtutu; Brian Wells
• Date Published: September 2001
• Length: 10 pages
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United Kingdom

Annotation

This article compares the characteristics, experiences, and outcomes of opiate-dependent clients receiving a prescription for heroin with those receiving a prescription for injectable methadone.

Abstract

This was an observational study of 58 clients attending a clinic between June 1995 and November 1997 and followed-up for 12 months. The eligibility criteria were: aged over 21 years; dependent on opiates; unable or unwilling to give up injecting; previously failing oral methadone treatment; and experiencing problems related to drug use in areas of health, crime, or social functioning. They were able to choose the type of injectable drug they received; either injectable diamorphine (heroin) or injectable methadone. Of the clients recruited to the study, 37 chose injectable heroin and 21 chose injectable methadone. The majority of both groups were unemployed, white males with similar median ages of 38 and 36 years, respectively. Both groups had long injecting careers and had reported using a range of illicit drugs in the 4 weeks prior to entering treatment. Most of the heroin group reported to their key workers that they were experiencing nighttime withdrawals due to the heroin’s relatively short duration of action and thus were given an additional prescription for oral methadone. The heroin group was significantly more likely to inject their prescribed drugs more frequently per day than the methadone group. While those choosing each drug had different baseline characteristics, both groups were well retained in treatment and at 3 months made significant reductions in drug use and crime, which were sustained over the 12-month follow-up period. There was no significant difference between treatment outcome between each group. There is a need to conduct randomized controlled trials to establish the effectiveness of prescribing injectable methadone and heroin to inform policy and practice. 7 tables, 23 references