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Heroin trials

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Co-ordinated by National Addictions Centre, Institute of Psychiatry ... Reported abstinence or significant decreases in illicit heroin use ... – PowerPoint PPT presentation

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Title: 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
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