Supervised Injectable Heroin After Failure of Oral Methadone Maintenance

At least 5% to 10% of heroin addicts continue illicit opiate use despite treatment with oral methadone. In several randomized trials, supervised injection of medicinal heroin was more effective than oral methadone in patients who failed to respond to conventional methadone maintenance, but methodological problems in those studies have left questions unresolved.

British researchers enrolled 127 adult heroin addicts (mostly unemployed white men; mean age, 37) who had injected illicit heroin regularly (on at least 45 of the previous 90 days) while in conventional oral methadone maintenance programs; participants were randomized to supervised administration of individualized doses of once-daily oral methadone, once-daily injectable methadone, or…