Poster (Scientific congresses and symposiums)
Heroin-assisted treatment showed better efficacy than methadone
ANSSEAU, Marc; Demaret, Isabelle
2014167th American Psychiatric Association Annual Meeting
 

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Keywords :
heroin-assisted treatment; diacetylmorphine; treatment duration
Abstract :
[en] 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.
Disciplines :
Public health, health care sciences & services
Author, co-author :
ANSSEAU, Marc ;  Centre Hospitalier Universitaire de Liège - CHU > Psychiatrie et psychologie médicale
Demaret, Isabelle ;  Université de Liège - ULiège > Département des sciences cliniques > Psychiatrie et psychologie médicale
Language :
English
Title :
Heroin-assisted treatment showed better efficacy than methadone
Alternative titles :
[fr] Le traitement assisté par héroïne a montré plus d'efficacité que le traitement par méthadone
Publication date :
04 May 2014
Number of pages :
A0
Event name :
167th American Psychiatric Association Annual Meeting
Event organizer :
American Psychiatric Association
Event place :
New-York, United States
Event date :
Du 3 au 7 mai 2014
Audience :
International
Funders :
SPF Santé - Service Public Fédéral Santé publique. Sécurité de la Chaîne alimentaire et Environnement [BE]
Liège - Ville de Liège [BE]
ULiège - Université de Liège [BE]
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since 03 July 2014

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