Drug use, health and social outcomes of hard-to-treat heroin addicts receiving Supervised Injectable Opiate Treatment: secondary outcomes from the Randomised Injectable Opioid Treatment Trial (RIOTT)

Nicola Metrebian; Teodora Groshkova; Jennifer Hellier; Vikki Charles; Anthea Martin; Luciana Forzisi; Nicholas Lintzeris; Deborah Zador; Hugh Williams; Tom Carnwath; Soraya Mayet; John Strang

doi:10.1111/add.12748

Drug use, health and social outcomes of hard-to-treat heroin addicts receiving Supervised Injectable Opiate Treatment: secondary outcomes from the Randomised Injectable Opioid Treatment Trial (RIOTT)

Nicola Metrebian, Teodora Groshkova, Jennifer Hellier, Vikki Charles, Anthea Martin, Luciana Forzisi, Nicholas Lintzeris, Deborah Zador, Hugh Williams, Tom Carnwath, Soraya Mayet, John Strang

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Abstract

Aims: The Randomized Injectable Opioid Treatment Trial (RIOTT) compared supervised injectable heroin (SIH) and supervised injectable methadone (SIM) with optimized oral methadone (OOM) (ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes. Design: Multi-site randomized controlled trial (RCT) comparing SIH versus OOM and SIM versus OOM. Setting: Three supervised injectable opiate clinics in England. Participants: Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment (n = 127), randomized to either SIH(n = 43), SIM(n = 42) or OOM(n = 42). All received high levels of medical and psychosocial support. Measurements: Secondary outcomes: wider drug use, crime, health and social functioning at 6 months. Findings: At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health (SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [SIH = odds ratio (OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs (SIH = mean change £–289.43; P < 0.001; SIM = mean change £–183.41; P < 0.001; OOM = mean change £–162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £–92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM (SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013). Conclusions: Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes.

Original language	English
Number of pages	12
Journal	Addiction
DOIs	https://doi.org/10.1111/add.12748
Publication status	E-pub ahead of print - 2014

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10.1111/add.12748

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Metrebian, N., Groshkova, T., Hellier, J., Charles, V., Martin, A., Forzisi, L., Lintzeris, N., Zador, D., Williams, H., Carnwath, T., Mayet, S., & Strang, J. (2014). Drug use, health and social outcomes of hard-to-treat heroin addicts receiving Supervised Injectable Opiate Treatment: secondary outcomes from the Randomised Injectable Opioid Treatment Trial (RIOTT). Addiction. Advance online publication. https://doi.org/10.1111/add.12748

@article{ef29e7d26977456f8c61db68540e5150,

title = "Drug use, health and social outcomes of hard-to-treat heroin addicts receiving Supervised Injectable Opiate Treatment: secondary outcomes from the Randomised Injectable Opioid Treatment Trial (RIOTT)",

abstract = "Aims: The Randomized Injectable Opioid Treatment Trial (RIOTT) compared supervised injectable heroin (SIH) and supervised injectable methadone (SIM) with optimized oral methadone (OOM) (ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes. Design: Multi-site randomized controlled trial (RCT) comparing SIH versus OOM and SIM versus OOM. Setting: Three supervised injectable opiate clinics in England. Participants: Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment (n = 127), randomized to either SIH(n = 43), SIM(n = 42) or OOM(n = 42). All received high levels of medical and psychosocial support. Measurements: Secondary outcomes: wider drug use, crime, health and social functioning at 6 months. Findings: At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health (SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [SIH = odds ratio (OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs (SIH = mean change £–289.43; P < 0.001; SIM = mean change £–183.41; P < 0.001; OOM = mean change £–162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £–92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM (SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013). Conclusions: Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes.",

author = "Nicola Metrebian and Teodora Groshkova and Jennifer Hellier and Vikki Charles and Anthea Martin and Luciana Forzisi and Nicholas Lintzeris and Deborah Zador and Hugh Williams and Tom Carnwath and Soraya Mayet and John Strang",

year = "2014",

doi = "10.1111/add.12748",

language = "English",

journal = "Addiction",

issn = "0965-2140",

publisher = "Wiley-Blackwell Publishing Ltd",

}

Metrebian, N , Groshkova, T , Hellier, J , Charles, V , Martin, A , Forzisi, L, Lintzeris, N, Zador, D, Williams, H, Carnwath, T, Mayet, S & Strang, J 2014, 'Drug use, health and social outcomes of hard-to-treat heroin addicts receiving Supervised Injectable Opiate Treatment: secondary outcomes from the Randomised Injectable Opioid Treatment Trial (RIOTT)', Addiction. https://doi.org/10.1111/add.12748

TY - JOUR

T1 - Drug use, health and social outcomes of hard-to-treat heroin addicts receiving Supervised Injectable Opiate Treatment

T2 - secondary outcomes from the Randomised Injectable Opioid Treatment Trial (RIOTT)

AU - Metrebian, Nicola

AU - Groshkova, Teodora

AU - Hellier, Jennifer

AU - Charles, Vikki

AU - Martin, Anthea

AU - Forzisi, Luciana

AU - Lintzeris, Nicholas

AU - Zador, Deborah

AU - Williams, Hugh

AU - Carnwath, Tom

AU - Mayet, Soraya

AU - Strang, John

PY - 2014

Y1 - 2014

N2 - Aims: The Randomized Injectable Opioid Treatment Trial (RIOTT) compared supervised injectable heroin (SIH) and supervised injectable methadone (SIM) with optimized oral methadone (OOM) (ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes. Design: Multi-site randomized controlled trial (RCT) comparing SIH versus OOM and SIM versus OOM. Setting: Three supervised injectable opiate clinics in England. Participants: Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment (n = 127), randomized to either SIH(n = 43), SIM(n = 42) or OOM(n = 42). All received high levels of medical and psychosocial support. Measurements: Secondary outcomes: wider drug use, crime, health and social functioning at 6 months. Findings: At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health (SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [SIH = odds ratio (OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs (SIH = mean change £–289.43; P < 0.001; SIM = mean change £–183.41; P < 0.001; OOM = mean change £–162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £–92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM (SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013). Conclusions: Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes.

AB - Aims: The Randomized Injectable Opioid Treatment Trial (RIOTT) compared supervised injectable heroin (SIH) and supervised injectable methadone (SIM) with optimized oral methadone (OOM) (ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes. Design: Multi-site randomized controlled trial (RCT) comparing SIH versus OOM and SIM versus OOM. Setting: Three supervised injectable opiate clinics in England. Participants: Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment (n = 127), randomized to either SIH(n = 43), SIM(n = 42) or OOM(n = 42). All received high levels of medical and psychosocial support. Measurements: Secondary outcomes: wider drug use, crime, health and social functioning at 6 months. Findings: At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health (SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [SIH = odds ratio (OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs (SIH = mean change £–289.43; P < 0.001; SIM = mean change £–183.41; P < 0.001; OOM = mean change £–162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £–92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM (SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013). Conclusions: Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes.

U2 - 10.1111/add.12748

DO - 10.1111/add.12748

M3 - Article

C2 - 25251885

SN - 0965-2140

JO - Addiction

JF - Addiction

ER -

Drug use, health and social outcomes of hard-to-treat heroin addicts receiving Supervised Injectable Opiate Treatment: secondary outcomes from the Randomised Injectable Opioid Treatment Trial (RIOTT)

Abstract

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