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[Drug and Alcohol Findings] (2012) Effectiveness Bank Bulletin. [Comorbidity effects on treatment outcome]. Drug and Alcohol Findings. Drug and Alcohol Findings, 25 Jan

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URL: http://findings.org.uk/docs/bulletins/Bull_25_01_1...

Effects of psychiatric comorbidity on treatment outcome in patients undergoing diamorphine or methadone maintenance treatment.
Schäfer I., Eiroa-Orosa F.J., Verthein U. et al. Psychopathology: 2010, 43, p. 88–95.

In Germany, heroin-addicted patients suffering from mental disorders benefited more from being prescribed heroin than methadone and did so to almost the same degree as other patients, including greater remission in psychiatric symptoms.

Summary
Whether heroin addicted patients also suffering from poor mental health benefit from being prescribed heroin was the question addressed by the featured report from the German heroin prescribing trial. This account draws on an earlier Findings analysis of the study, of which the featured report was a sub-study.

The parent study trialled the prescribing of heroin for the treatment of heroin addiction at seven German clinics. Over the years 2002 and 2003 it successfully recruited 1015 patients who were regularly injecting heroin and in poor physical or mental health despite being in methadone maintenance treatment, or having been treated for their addiction in the past, but not in the last six months.

Patients were randomly allocated to either be prescribed heroin to be taken under supervision at the clinics plus oral methadone, or only oral methadone. Cutting across this allocation, they were also randomly allocated to two forms of psychosocial support: case management conducted along motivational interviewing lines and intended to flexibly coordinate an individualised care package from various services; or a more standard and directly delivered series of individual counselling and group therapy sessions. Which of these support programmes a patient was allocated to made no difference to the main outcomes, so reports have focused on the pharmacotherapy options.

Earlier reports recorded that compared to methadone, the heroin option retained more patients for a year and enabled more to substantially curb illicit heroin use without countervailing increases in cocaine use. More heroin patients also experienced improved health. However, the new methadone programme was itself far from ineffective; though previous treatment had been unsuccessful, many methadone patients also substantially cut their heroin use and experienced improved health.


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