Heroin trials

1
Heroin trials

• RIOTT in Brighton
• Chief Investigator Professor John Strang
• Local site investigator Dr Hugh Williams

2
Funding and support

• Co-ordinated by National Addictions Centre,
  Institute of Psychiatry
• Research Funding Big Lottery and AonA
• Clinical services NTA/ Department of Health

3
Background

• Some opioid dependent injecting drug users appear
  unable to make much progress with oral methadone
  treatment.
• Lack of consensus on how to treat these drug
  users
• Government called for heroin prescribing to be
  expanded
• NTA guidance

4
New pilot supervised injecting clinics

• 7 days per week under supervision
• Higher daily doses no take-home injections
• Oral methadone supplements
• Flexible prescribing oral TTA conversion on
  request
• Dedicated facility specific function

5
Research aim

• Examine the safety, efficacy and cost
  effectiveness of treatment with injectable opioid
  treatment (methadone and heroin) compared to
  optimised oral methadone

6
Research Hypotheses

• That a selected group of patients (not responding
  to their current oral methadone treatment)
  receiving injectable opioid treatment will make
  greater reductions in their illicit heroin use,
  than if provided with optimised oral methadone
  treatment
• Providing injectable opioids to a selected group
  of patients (not responding to their current oral
  methadone treatment) results in a greater
  economic benefit per extra unit of resource
  invested in the treatment than only offering
  optimised oral methadone

7
Research design

• Multi site RCT comparing 3 conditions
• - optimised oral methadone
• - injected methadone (/- oral methadone)
• - injected heroin (/- oral methadone)
• sample of 150 subjects not responding to
  methadone treatment
• 3 6 month follow up

8
Outcome measures

• Primary outcome reduction in illicit heroin use
• Secondary outcome
• - other illicit use
• - treatment retention
• - injecting practices
• - psychosocial functioning and quality of life
  measures
• - crime
• - satisfaction
• - safety
• - cost effectiveness

9
Recruitment

• Self referral
• Since start of trial in Brighton
• 102 referral forms
• 50 medically screened
• 32 eligible
• 28 have been randomised to the trial

10
Service delivery

• Opened September 2007
• Minimum 3 staff
• Daily am and pm clinics 365 days
• Reception/ waiting area
• Adjacent room with 3 custom-built cubicles

11
Service delivery

• Pre and post dose assessment
• Hand-washing prior to injecting
• Weekly key-working first 2 months

12
Benefits

• Significant health promotion role
• Screening process identified physical conditions
  perhaps otherwise undetected - routine blood
  screen and ECGs
• 100 BBV screening, vaccination and follow up
• Intensive key working

13
Challenges

• Moving patients away from groin injecting
• Alcohol misuse
• Alternative structure/occupation of time

14
Clinical impressions

• Observed improvement in physical and mental
  health illicit use
• Improvements in all 3 treatment arms.
• Good retention in treatment indicator of
  positive outcomes

15
Client Perspective

• Verbal feedback very positive across all 3
  treatment arms
• Reported abstinence or significant decreases in
  illicit heroin use
• Most clients post-6 months looking to progress
  with next stages of treatment