Heroin-assisted treatment showed better efficacy than methadone

Background: A fraction of patients receiving methadone treatment pursues their
use of street heroin. In Switzerland, a new treatment with prescribed diacetylmorphine
(pharmaceutical heroin) was developed to help these heroin addicts resistant to
methadone treatment to decrease their street heroin use. In this heroin-assisted
treatment (HAT), diacetylmorphine is prescribed to severe heroin user and
diacetylmorphine is administered by patients under the supervision of nurses in a
specific centre. Six randomised controlled trials compared HAT to methadone
treatment: in Switzerland, The Netherlands, Spain, Germany, Canada and United-
Kingdom. HAT showed better efficacy than methadone. Patients used less street
heroin, their health improved and their criminal behaviour decreased. A new trial
assessed in Belgium the feasibility and efficacy of this treatment compared to
methadone treatment.
Methods: The TADAM (Treatment Assisted by Diacetylmorphine) was an open label
randomised controlled trial developed on the Swiss model of HAT developed in 1994.
Main inclusion criteria were 5 years of heroin addiction, (almost) daily use of street
heroin and a previous attempt of methadone treatment. As in the Dutch experiment,
patients could choose to inhale or to inject diacetylmorphine in the new HAT centre.
HAT was stopped after 12 months and the best available treatment was offered to the
patient. The research team assessed subjects every three months with standardised
questionnaires (EuropASI, MAP-HSS, SCL-90-R) and questions on involvement in a
criminal milieu. We completed our reported data with toxicological analysis and
criminal proceedings.
Results: 74 subjects were randomised in the trial: 36 in the experimental group and
38 in the control group. According to the primary efficacy criterion, the experimental
group counted at least 30% more responders than the control group after 3 months
(p<0.05), 6 months (p<0.05) and 9 months (p<0.01). At the 12 month assessment, the
number of responders was still higher in the experimental group but the difference
(11%) was no more significant (p=0.35). At the 12 month assessment, the condition of
patients in the experimental group worsened compared to the 9 month assessment.
This effect was not seen in the control group were patients could continue their
methadone treatment after the 12 months.
Conclusion: As in other countries, HAT is an effective treatment for severe heroin
addicts resistant to methadone treatment. However, a predetermined duration of 12
month counteracts the efficacy of this treatment.