Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial

John Strang; Nicola Metrebian; Nicholas Lintzeris; Laura Potts; Tom Carnwath; Soraya Mayet; Hugh Williams; Deborah Zador; Richard Evers; Teodora Groshkova; Vikki Charles; Anthea Martin; Luciana Forzisi

doi:10.1016/S0140-6736(10)60349-2

Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial

John Strang, Nicola Metrebian, Nicholas Lintzeris, Laura Potts, Tom Carnwath, Soraya Mayet, Hugh Williams, Deborah Zador, Richard Evers, Teodora Groshkova, Vikki Charles, Anthea Martin, Luciana Forzisi

Research output: Contribution to journal › Article › peer-review

160 Citations (Scopus)

Abstract

Background Some heroin addicts persistently fail to benefit from conventional treatments. We aimed to compare the effectiveness of supervised injectable treatment with medicinal heroin (diamorphine or diacetylmorphine) or supervised injectable methadone versus optimised oral methadone for chronic heroin addiction. Methods In this multisite, open-label, randomised controlled trial, we enrolled chronic heroin addicts who were receiving conventional oral treatment (>= 6 months), but continued to inject street heroin regularly (>= 50% of days in preceding 3 months). Randomisation by minimisation was used to assign patients to receive supervised injectable methadone, supervised injectable heroin, or optimised oral methadone. Treatment was provided for 26 weeks in three supervised injecting clinics in England. Primary outcome was 50% or more of negative specimens for street heroin on weekly urinalysis during weeks 14-26. Primary analysis was by intention to treat; data were adjusted for centre, regular crack use at baseline, and treatment with optimised oral methadone at baseline. Percentages were calculated with Rubin's rules and were then used to estimate numbers of patients in the multiple imputed samples. This study is registered, ISRCTN01338071. Findings Of 301 patients screened, 127 were enrolled and randomly allocated to receive injectable methadone (n=42 patients), injectable heroin (n=43), or oral methadone (n=42); all patients were included in the primary analysis. At 26 weeks, 80% (n=101) patients remained in assigned treatment: 81% (n=34) on injectable methadone, 88% (n=38) on injectable heroin, and 69% (n=29) on oral methadone. Patients on injectable heroin were significantly more likely to have achieved the primary outcome (72% [n=31]) than were those on oral methadone (27% [n=11], OR 7.42,95% CI 2.69-20.46, p

Original language	English
Pages (from-to)	1885 - 1895
Number of pages	11
Journal	The Lancet
Volume	375
Issue number	9729
DOIs	https://doi.org/10.1016/S0140-6736(10)60349-2
Publication status	Published - 2010

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Strang, J., Metrebian, N., Lintzeris, N., Potts, L., Carnwath, T., Mayet, S., Williams, H., Zador, D., Evers, R., Groshkova, T., Charles, V., Martin, A., & Forzisi, L. (2010). Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial. The Lancet, 375(9729), 1885 - 1895. https://doi.org/10.1016/S0140-6736(10)60349-2

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title = "Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial",

abstract = "Background Some heroin addicts persistently fail to benefit from conventional treatments. We aimed to compare the effectiveness of supervised injectable treatment with medicinal heroin (diamorphine or diacetylmorphine) or supervised injectable methadone versus optimised oral methadone for chronic heroin addiction. Methods In this multisite, open-label, randomised controlled trial, we enrolled chronic heroin addicts who were receiving conventional oral treatment (>= 6 months), but continued to inject street heroin regularly (>= 50% of days in preceding 3 months). Randomisation by minimisation was used to assign patients to receive supervised injectable methadone, supervised injectable heroin, or optimised oral methadone. Treatment was provided for 26 weeks in three supervised injecting clinics in England. Primary outcome was 50% or more of negative specimens for street heroin on weekly urinalysis during weeks 14-26. Primary analysis was by intention to treat; data were adjusted for centre, regular crack use at baseline, and treatment with optimised oral methadone at baseline. Percentages were calculated with Rubin's rules and were then used to estimate numbers of patients in the multiple imputed samples. This study is registered, ISRCTN01338071. Findings Of 301 patients screened, 127 were enrolled and randomly allocated to receive injectable methadone (n=42 patients), injectable heroin (n=43), or oral methadone (n=42); all patients were included in the primary analysis. At 26 weeks, 80% (n=101) patients remained in assigned treatment: 81% (n=34) on injectable methadone, 88% (n=38) on injectable heroin, and 69% (n=29) on oral methadone. Patients on injectable heroin were significantly more likely to have achieved the primary outcome (72% [n=31]) than were those on oral methadone (27% [n=11], OR 7.42,95% CI 2.69-20.46, p",

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

year = "2010",

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language = "English",

volume = "375",

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Strang, J , Metrebian, N, Lintzeris, N, Potts, L, Carnwath, T, Mayet, S, Williams, H, Zador, D, Evers, R, Groshkova, T , Charles, V , Martin, A & Forzisi, L 2010, 'Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial', The Lancet, vol. 375, no. 9729, pp. 1885 - 1895. https://doi.org/10.1016/S0140-6736(10)60349-2

Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial. / Strang, John ; Metrebian, Nicola; Lintzeris, Nicholas et al.
In: The Lancet, Vol. 375, No. 9729, 2010, p. 1885 - 1895.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial

AU - Strang, John

AU - Metrebian, Nicola

AU - Lintzeris, Nicholas

AU - Potts, Laura

AU - Carnwath, Tom

AU - Mayet, Soraya

AU - Williams, Hugh

AU - Zador, Deborah

AU - Evers, Richard

AU - Groshkova, Teodora

AU - Charles, Vikki

AU - Martin, Anthea

AU - Forzisi, Luciana

PY - 2010

Y1 - 2010

N2 - Background Some heroin addicts persistently fail to benefit from conventional treatments. We aimed to compare the effectiveness of supervised injectable treatment with medicinal heroin (diamorphine or diacetylmorphine) or supervised injectable methadone versus optimised oral methadone for chronic heroin addiction. Methods In this multisite, open-label, randomised controlled trial, we enrolled chronic heroin addicts who were receiving conventional oral treatment (>= 6 months), but continued to inject street heroin regularly (>= 50% of days in preceding 3 months). Randomisation by minimisation was used to assign patients to receive supervised injectable methadone, supervised injectable heroin, or optimised oral methadone. Treatment was provided for 26 weeks in three supervised injecting clinics in England. Primary outcome was 50% or more of negative specimens for street heroin on weekly urinalysis during weeks 14-26. Primary analysis was by intention to treat; data were adjusted for centre, regular crack use at baseline, and treatment with optimised oral methadone at baseline. Percentages were calculated with Rubin's rules and were then used to estimate numbers of patients in the multiple imputed samples. This study is registered, ISRCTN01338071. Findings Of 301 patients screened, 127 were enrolled and randomly allocated to receive injectable methadone (n=42 patients), injectable heroin (n=43), or oral methadone (n=42); all patients were included in the primary analysis. At 26 weeks, 80% (n=101) patients remained in assigned treatment: 81% (n=34) on injectable methadone, 88% (n=38) on injectable heroin, and 69% (n=29) on oral methadone. Patients on injectable heroin were significantly more likely to have achieved the primary outcome (72% [n=31]) than were those on oral methadone (27% [n=11], OR 7.42,95% CI 2.69-20.46, p

AB - Background Some heroin addicts persistently fail to benefit from conventional treatments. We aimed to compare the effectiveness of supervised injectable treatment with medicinal heroin (diamorphine or diacetylmorphine) or supervised injectable methadone versus optimised oral methadone for chronic heroin addiction. Methods In this multisite, open-label, randomised controlled trial, we enrolled chronic heroin addicts who were receiving conventional oral treatment (>= 6 months), but continued to inject street heroin regularly (>= 50% of days in preceding 3 months). Randomisation by minimisation was used to assign patients to receive supervised injectable methadone, supervised injectable heroin, or optimised oral methadone. Treatment was provided for 26 weeks in three supervised injecting clinics in England. Primary outcome was 50% or more of negative specimens for street heroin on weekly urinalysis during weeks 14-26. Primary analysis was by intention to treat; data were adjusted for centre, regular crack use at baseline, and treatment with optimised oral methadone at baseline. Percentages were calculated with Rubin's rules and were then used to estimate numbers of patients in the multiple imputed samples. This study is registered, ISRCTN01338071. Findings Of 301 patients screened, 127 were enrolled and randomly allocated to receive injectable methadone (n=42 patients), injectable heroin (n=43), or oral methadone (n=42); all patients were included in the primary analysis. At 26 weeks, 80% (n=101) patients remained in assigned treatment: 81% (n=34) on injectable methadone, 88% (n=38) on injectable heroin, and 69% (n=29) on oral methadone. Patients on injectable heroin were significantly more likely to have achieved the primary outcome (72% [n=31]) than were those on oral methadone (27% [n=11], OR 7.42,95% CI 2.69-20.46, p

U2 - 10.1016/S0140-6736(10)60349-2

DO - 10.1016/S0140-6736(10)60349-2

M3 - Article

SN - 1474-547X

VL - 375

SP - 1885

EP - 1895

JO - The Lancet

JF - The Lancet

IS - 9729

ER -