Addictions Department, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK.
Addiction. 2015 Mar;110(3):479-90. doi: 10.1111/add.12748. Epub 2014 Nov 7.
The Randomized Injectable Opioid Treatment Trial (RIOTT) compared supervised injectable heroin (SIH) and supervised injectable methadone (SIM) with optimized oral methadone (OOM) (ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes.
Multi-site randomized controlled trial (RCT) comparing SIH versus OOM and SIM versus OOM.
Three supervised injectable opiate clinics in England.
Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment (n = 127), randomized to either SIH(n = 43), SIM(n = 42) or OOM(n = 42). All received high levels of medical and psychosocial support.
wider drug use, crime, health and social functioning at 6 months.
At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health (SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [SIH = odds ratio (OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs (SIH = mean change £-289.43; P < 0.001; SIM = mean change £-183.41; P < 0.001; OOM = mean change £-162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £-92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM (SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013).
Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes.
随机注射类阿片治疗试验（RIOTT）比较了监督下注射海洛因（SIH）和监督下注射美沙酮（SIM）与优化的口服美沙酮（OOM）（ISRCTN0133807）。在接受 SIH 治疗的 6 个月时，以前对治疗无反应的海洛因成瘾者显著减少了街头海洛因的使用。我们现在检查次要结果。
多地点随机对照试验（RCT）比较 SIH 与 OOM 和 SIM 与 OOM。
英国三个监督注射阿片类药物诊所。
慢性难治性海洛因成瘾者继续几乎每天注射街头海洛因，尽管接受了口服替代治疗（n=127），随机分为 SIH（n=43）、SIM（n=42）或 OOM（n=42）。所有人都接受了高水平的医疗和心理社会支持。
6 个月时更广泛的药物使用、犯罪、健康和社会功能。
在 6 个月时，治疗组之间在更广泛的药物使用（冰毒/可卡因、苯二氮卓类药物、酒精）、身体和心理健康（SF-36）或社会功能方面没有发现显著差异。在每个治疗组中，犯罪行为均显著减少[SIH=比值比（OR）0.05；P<0.001；SIM=OR 0.11；P=0.002；OOM=OR 0.11；P=0.003]，每周用于非法药物的支出也减少（SIH=平均变化£-289.43；P<0.001；SIM=平均变化£-183.41；P<0.001；OOM=平均变化£-162.80；P<0.001），与 OOM 相比，海洛因的支出减少更为显著（平均差异£-92.04；P<0.001）。SIH 和 SIM 组的身体健康状况显著改善（SIH=平均变化 3.97；P=0.008；SIM=平均变化 4.73；P=0.002），OOM 组的心理健康状况显著改善（平均变化 6.04；P=0.013）。
在 6 个月内，尽管监督下注射海洛因治疗和监督下注射美沙酮治疗在减少街头海洛因使用方面比优化的口服美沙酮更有效，但在更广泛的药物使用、犯罪、身体和心理健康方面，并未明显优于优化的口服美沙酮。然而，所有干预措施都与这些结果的改善有关。
