Prescribing drug of choice to opiate dependent drug users: a comparison ofclients receiving heroin with those receiving injectable methadone at a West London drug clinic

Fifty-eight long-term treatment resistant opiate-dependent drug users were offered the choice of receiving injectable heroin or injectable methadone a t a West London drug clinic. Drugs were dispensed on-site at the clinic wit h weekend take-home. There was no routine ongoing supervised injecting. A c eiling dose of 200 mg/day of heroin or methadone was set. One-third chose i njectable methadone. Compared to those choosing heroin, these drug users we re less likely to have used heroin or crack/cocaine before entering treatme nt, and were more likely to have previously received treatment with injecta ble methadone. Drug users reported choosing methadone because it was their primary drug of addiction, and compared with heroin has a longer duration o f action and increased strength. Problems with each drug were reported: tho se choosing heroin complained that the upper dose limit was too low to main tain them adequately, and some receiving methadone complained of discomfort while injecting intravenously. While those choosing each drug had differen t baseline characteristics, both groups were well retained in treatment and at 3 months made significant reductions in drug use and crime, which were sustained over the 12-month follow-up period. There was no significant diff erence between treatment outcome between each group. There is an urgent nee d to conduct randomized controlled trials to establish the effectiveness of prescribing injectable methadone and heroin to inform policy and practice.