News archive 2010
‘Medical’ heroin a success in RIOTT trials28 May 2010, PR 123/10
Supervised administration of injectable ‘medical’ grade heroin leads to larger reductions in street heroin use in chronic heroin addicts who are failing on treatment, than does either injectable or oral methadone. The findings of the Randomised Injectable Opiate Treatment Trial (RIOTT) trial are reported in an article in this week’s Lancet, written by Professor John Strang and colleagues from the National Addiction Centre, Institute of Psychiatry (IoP) at King’s.
At least 5–10 per cent of heroin addicts fail to benefit from established conventional treatments but whether they are untreatable or just difficult to treat is unknown. A scientific evidence base is emerging to support the effectiveness of maintenance treatment with directly supervised medicinal heroin (diamorphine or diacetylmorphine) as a second-line treatment for chronic heroin addiction.
This randomised controlled trial looked at chronic heroin addicts who were receiving conventional oral treatment but continued to inject street heroin regularly. Patients were assigned to receive supervised injectable methadone, supervised injectable heroin, or optimised oral methadone. Treatment was provided for 26 weeks in three National Health Service (NHS) supervised injecting clinics in England (London, Brighton and Darlington). During weeks 14–26, 50 per cent or more tested negative for street heroin on weekly random urine analysis.
Lower use of street heroin
The researchers found that at 26 weeks, 80 per cent of patients remained in assigned treatment - 81 per cent on supervised injectable methadone, 88 per cent on supervised injectable heroin and 69 per cent on optimised oral methadone. Proportions of patients achieving 50 per cent or more negative samples for street heroin were highest in the injectable heroin group (66 per cent) followed by injectable methadone (30 per cent) and oral methadone (19 per cent). The measure of measurable improvement, the pre-selected primary outcome, was that, through months 4-6, at least 50 per cent of randomly collected urines tested negative for street heroin (from weekly random urine analysis). The authors report on 'abstinence from street heroin' also, and a similar greater benefit of the supervised heroin treatment was seen, compared with the other two treatments.
The authors say: 'We have shown that treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone. Furthermore, this difference was evident within the first six weeks of treatment.'
They conclude: 'Rolling out the prescription of injectable heroin and methadone to clients who do not respond to other forms of treatment, is detailed in the UK Government’s 2008 Drug Strategy, subject to the results from this trial. In the past 15 years, six randomised trials have all reported benefits from treatment with injectable heroin compared with oral methadone. Supervised injectable heroin should now be provided, with close monitoring, for carefully selected chronic heroin addicts in the UK.'
Professor Strang said: 'Our scientific understanding about how to treat people with severe heroin addiction has taken an important step forward. The RIOTT study shows that previously unresponsive patients can achieve major reductions in their use of street heroin and, impressively, these outcomes were seen within six weeks. Our work offers government robust evidence to support the expansion of this treatment, so that more patients can benefit.'
The National Addiction Centre is jointly run by the IoP and South London and Maudsley NHS Foundation Trust. Both are part of King's Health Partners, an Academic Health Sciences Centre (AHSC) for London, bringing together clinical and research expertise across both physical and mental health.
Notes to editors
Further information and podcast
The article ‘Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial’ can be found on the Lancet website, along with a podcast featuring Professor Strang discussing the trial. Professor Strang can be seen also on the new SLaM website talking about RIOTT: http://www.slam.nhs.uk/news/latest-news/treating-heroin-addiction.aspx.
King's College London
King's College London is one of the top 25 universities in the world (Times Higher Education 2009) and the fourth oldest in England. A research-led university based in the heart of London, King's has nearly 23,000 students (of whom more than 8,600 are graduate students) from nearly 140 countries, and some 5,500 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.
King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £450 million.
King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.
King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: www.kingshealthpartners.org.
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