Objective To determine whether supervised medical prescription of
heroin can successfully treat addicts who do not sufficiently benefit from
methadone maintenance treatment.
Design Two open label randomised controlled trials.
Setting Methadone maintenance programmes in six cities in the
Participants 549 heroin addicts.
Interventions Inhalable heroin (n = 375) or injectable heroin (n =
174) prescribed over 12 months. Heroin (maximum 1000 mg per day) plus
methadone (maximum 150 mg per day) compared with methadone alone (maximum 150
mg per day). Psychosocial treatment was offered throughout.
Main outcome measures Dichotomous, multidomain response index,
including validated indicators of physical health, mental status, and social
Results Adherence was excellent with 12 month outcome data available
for 94% of the randomised participants. With intention to treat analysis, 12
month treatment with heroin plus methadone was significantly more effective
than treatment with methadone alone in the trial of inhalable heroin (response
rate 49.7% v 26.9%; difference 22.8%, 95% confidence interval 11.0%
to 34.6%) and in the trial of injectable heroin (55.5% v 31.2%;
difference 24.3%, 9.6% to 39.0%). Discontinuation of the coprescribed heroin
resulted in a rapid deterioration in 82% (94/115) of those who
responded to the coprescribed heroin. The incidence of serious adverse events
was similar across treatment conditions.
Conclusions Supervised coprescription of heroin is feasible, more
effective, and probably as safe as methadone alone in reducing the many
physical, mental, and social problems of treatment resistant heroin