Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlands
Version of Record online: 17 NOV 2009
© 2009 The Authors. Journal compilation © 2009 Society for the Study of Addiction
Volume 105, Issue 2, pages 300–308, February 2010
How to Cite
Blanken, P., Hendriks, V. M., Van Ree, J. M. and Van Den Brink, W. (2010), Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlands. Addiction, 105: 300–308. doi: 10.1111/j.1360-0443.2009.02754.x
- Issue online: 11 JAN 2010
- Version of Record online: 17 NOV 2009
- Submitted 26 September 2008; initial review completed 23 December 2008; final version accepted 28 July 2009
- heroin-assisted treatment;
- long-term outcome;
- opioid dependence
Aims To describe 4-year treatment retention and treatment response among chronic, treatment-resistant heroin-dependent patients offered long-term heroin-assisted treatment (HAT) in the Netherlands.
Design Observational cohort study.
Setting and intervention Out-patient treatment in specialized heroin treatment centres in six cities in the Netherlands, with methadone plus injectable or inhalable heroin offered 7 days per week, three times per day. Prescription of methadone plus heroin was supplemented with individually tailored psychosocial and medical support.
Participants Heroin-dependent patients who had responded positively to HAT in two randomized controlled trials and were eligible for long-term heroin-assisted treatment (n = 149).
Measurements Primary outcome measures were treatment retention after 4 years and treatment response on a dichotomous, multi-domain response index, comprising physical, mental and social health and illicit substance use.
Findings Four-year retention was 55.7% [95% confidence interval (CI): 47.6–63.8%].
Treatment Response was significantly better for patients continuing 4 years of HAT compared to patients who discontinued treatment: 90.4% versus 21.2% [difference 69.2%; odds ratio (OR) = 48.4, 95% CI: 17.6–159.1]. Continued HAT treatment was also associated with an increasing proportion of patients without health problems and who had stopped illicit drug and excessive alcohol use: from 12% after the first year to 25% after 4 years of HAT.
Conclusions Long-term HAT is an effective treatment for chronic heroin addicts who have failed to benefit from methadone maintenance treatment. Four years of HAT is associated with stable physical, mental and social health and with absence of illicit heroin use and substantial reductions in cocaine use. HAT should be continued as long as there is no compelling reason to stop treatment.