Commentary on Blanken et al. (2010): long-term heroin-assisted treatment-some more questions and answers.

摘要

The paper by Peter Blanken and colleagues [1] reports on 4-year outcomes of 147 patients who completed the 12-month Dutch randomized controlled trial (RCT) of injectable or inhalable heroin-assisted treatment (HAT) [2], and who then subsequently continued in HAT following the initial trial. Patients were able to remain in HAT if they did not transgress programme rules (e.g. attempted diversion of medications), and continued to have positive outcomes with regard to substance use and related health and psychosocial domains. Patients who did not demonstrate positive outcomes were discontinued from HAT and returned to oral methadone treatment. During the 4 years, 66 of 147 subjects were discontinued from HAT for the following reasons: poor outcomes (30.3%), administrative discharge (42.4%), left to their own volition (22.7%, including 10.6% who achieved abstinence) or incarceration (4.6%). Within this context, the findings of this report are to be expected-that those individuals who responded positively (and remained) in HAT over the 4 years had better outcomes than those individuals who were discharged from HAT, even though the majority (85%) of HAT discharges were in methadone treatment at the 4-year follow-up.