Trial reportBMJ (Clinical research ed.)2003
Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials.
Trial report in BMJ (Clinical research ed.), 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 78 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
78 citing papers in PubMed, 8 syntheses or guidelines pooled it, 348 citations in OpenAlex.
- Oral and injectable opioid agonist treatments for people who use street opioids: a systematic literature review and network meta-analysis.BMC public health · 2025Pooled it
- Economic Evaluation in Opioid Modeling: Systematic Review.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2021Pooled it
- Pooled it
- Injectable opioid agonist treatment for opioid use disorder: a national clinical guideline.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2019Guideline
- Supervised dosing with a long-acting opioid medication in the management of opioid dependence.The Cochrane database of systematic reviews · 2017Pooled it
- Retention in medication-assisted treatment for opiate dependence: A systematic review.Journal of addictive diseases · 2016Pooled it
- Heroin maintenance for chronic heroin-dependent individuals.The Cochrane database of systematic reviews · 2011Pooled it
- Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials.BMJ (Clinical research ed.) · 2005Pooled it
- Effects of cortisol administration on craving in heroin addicts.Translational psychiatry · 2015Trial
- Normalizing effect of heroin maintenance treatment on stress-induced brain connectivity.Brain : a journal of neurology · 2015Trial
- Diacetylmorphine versus methadone for the treatment of opioid addiction.The New England journal of medicine · 2009Trial
- Trial
- Scientific and political challenges in North America's first randomized controlled trial of heroin-assisted treatment for severe heroin addiction: rationale and design of the NAOMI study.Clinical trials (London, England) · 2009Trial
- Population pharmacokinetics of heroin and its major metabolites.Clinical pharmacokinetics · 2006Trial
- Characteristics and response to treatment among Aboriginal people receiving heroin-assisted treatment.Canadian journal of public health = Revue canadienne de sante publiqueTrial
- An ethical defense of safer supply.Theoretical medicine and bioethics · 2026Article
- Pharmacological Management of Opioid Use Disorder: A Systematic Review and Network Meta-Analysis: Prise en charge pharmacologique du trouble de l'usage des opiacés : revue systématique et méta-analyse en réseau.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2026Review
- [The diamorphine treatment of opioid addicts-On the amendment of the indication criteria according to the narcotics prescription regulation].Der Nervenarzt · 2026Article
- Review
- Operational and clinical procedures of heroin-assisted treatment in Switzerland: a nation-wide survey study.Harm reduction journal · 2025Article
18 more citing papers are in PubMed but not listed here.
Corrections and comments
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- Erratum issued
Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine whether supervised medical prescription of heroin can successfully treat addicts who do not sufficiently benefit from methadone maintenance treatment.
designTwo open label randomised controlled trials.
settingMethadone maintenance programmes in six cities in the Netherlands.
participants549 heroin addicts.
interventionsInhalable heroin (n = 375) or injectable heroin (n = 174) prescribed over 12 months. Heroin (maximum 1000 mg per day) plus methadone (maximum 150 mg per day) compared with methadone alone (maximum 150 mg per day). Psychosocial treatment was offered throughout.
main outcome measuresDichotomous, multidomain response index, including validated indicators of physical health, mental status, and social functioning.
resultsAdherence was excellent with 12 month outcome data available for 94% of the randomised participants. With intention to treat analysis, 12 month treatment with heroin plus methadone was significantly more effective than treatment with methadone alone in the trial of inhalable heroin (response rate 49.7% v 26.9%; difference 22.8%, 95% confidence interval 11.0% to 34.6%) and in the trial of injectable heroin (55.5% v 31.2%; difference 24.3%, 9.6% to 39.0%). Discontinuation of the coprescribed heroin resulted in a rapid deterioration in 82% (94/115) of those who responded to the coprescribed heroin. The incidence of serious adverse events was similar across treatment conditions.
conclusionsSupervised coprescription of heroin is feasible, more effective, and probably as safe as methadone alone in reducing the many physical, mental, and social problems of treatment resistant heroin addicts.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.