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Long-term effects of heroin-assisted treatment in Germany


Uwe Verthein, Centre for Interdisciplinary Addiction Research of Hamburg University, CIAR, University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany. E-mail:


Aims  Trials in Switzerland, the Netherlands and Spain have found that heroin-assisted treatment (HAT) as maintenance treatment for opioid-dependent patients reduces illicit drug use. A German trial also found diamorphine treatment to be superior to methadone treatment. The present study describes the association between 2 years of heroin treatment and improvements in health and social stabilization, as well as illicit drug use.

Design  A prospective cohort study design.

Participants  A total of 515 patients were assigned to diamorphine treatment; 278 patients remained in the study treatment for the entire period of 24 months (54.8%).

Measurements  The results on physical (Opiate Treatment Index Health Symptoms Scale) and mental (Symptom Checklist 90–Revised Global Severity Index) health and illicit drug use (number of days with drug use within the last month—European Addiction Severity Index) were examined by repeated-measures analyses.

Findings  Symptoms of physical (Pillai's trace = 0.837, df = 4, P < 0.001) and mental health (Pillai's trace = 0.450, df = 4, P < 0.001) improved during treatment. Street heroin use declined rapidly (Pillai's trace = 0.836, df = 4, P < 0.001), as did cocaine use (Pillai's trace = 0.280, df = 4, P < 0.001).

Conclusions  HAT is associated with improvements in mental and physical health in the long term.