HEROIN TRIAL REVIEWS

A colleague recently asked about review articles on heroin precribing for opiate addiction. The following response was sent, BUT ADDITIONAL REVIEW ARTICLES WOULD BE WELCOMED - please post.

There are various national trials that have been described - Netherlands, Germany, Switzerland, but the most objective overviews of everything available in the field comes from the Cochrane reviews, and there I find two references. One very recent, 2006, and I find nothing yet available except the abstract but maybe you can do better. Conclusion from abstract reads ( found at http://www.cochrane.org/reviews/en/ab003410.html)

Authors' conclusions No definitive conclusions about the overall effectiveness of heroin prescription is possible. Results favouring heroin treatment come from studies conducted in countries where easily accessible Methadone Maintenance Treatment at effective dosages is available. In those studies heroin prescription was addressed to patients who had failed previous methadone treatments. The present review contains information about ongoing trials which results will be integrated as soon as available.
Second review is 2 yrs old, and conclusion is: (found at http://www.cochrane.org/colloquia/abstracts/ottawa/P-004.htm)

Conclusions: Data from systematic reviews show MMT at appropriate doses the most effective in retaining patients in treatment and suppressing heroin use. The available evidence calls for two different actions in terms of clinical practice and research. On one side, proper methadone therapy should be offered to patients but on the other side future clinical trials should select clinically relevant alternative interventions to compare, include a diverse population of study participants, recruit participants from heterogeneous practice settings and heterogeneous social contexts, and collect data on a broad range of health outcomes.