Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: a follow-up study

Background Heroin-assisted substitution treatment for severely opioid-depen dent drug users has been available in Switzerland since 1994. Our aim was t o ascertain the feasibility, safety, and efficacy of this treatment. Methods We did a cohort study in 21 community outpatient treatment centres. We assessed 1969 opioid-dependent drug users, who began heroin-assisted su bstitution treatment between January, 1994, and December, 2000, to ascertai n admission and discharge patterns, and patient characteristics. We also fo llowed up a subset of 237 patients who began treatment between Jan 1, 1994, and March 31, 1995, and who stayed with the programme for at least 18 mont hs. We used questionnaires, interviews, and medical examinations done at en try and after 6, 12, and 18 months to assess somatic and mental health, soc ial integration, and treatment outcomes. Findings More than 70% (1378) of patients remained in treatment for more th an a year. Treatment showed positive effects with respect to health and soc ial outcomes. A long stay in treatment was related to a higher chance of st arting abstinence-oriented therapy than a short stay. Interpretation: Heroin-assisted substitution treatment might be an effectiv e option for chronically addicted patients for whom other treatments have f ailed.