Craving and illicit heroin use among patients in heroin-assisted treatment

Aims: To investigate in heroin-assisted treatment (HAT) compared to methadone maintenance treatment (MMT): the course of heroin craving and illicit heroin use, their mutual association, and their association with multi-domain treatment response. Design: RCTs on the efficacy of 12 months co-prescribed injectable or inhalable HAT compared to 12 months continued oral MMT. Setting: Outpatient treatment in MMT- or specialized HAT-centers in the Netherlands. Participants: Chronic, treatment-refractory heroin dependent patients (n=73). Study parameters: General craving for heroin (Obsessive Compulsive Drug Use Scale): self-reported illicit heroin use; multi-domain treatment response in physical, mental and social health and illicit drug use. Findings: The course of heroin craving and illicit heroin use differed significantly, with strong reductions in HAT but not in MMT. General heroin craving was significantly related to illicit heroin use. Heroin craving was not and illicit heroin use was marginally related to multi-domain treatment response, but only in MMT and not in HAT. Conclusions: Heroin craving and illicit heroin use were significantly associated and both strongly decreased in HAT but not in MMT. Craving was not related to multi-domain treatment response and illicit heroin use was marginally related to treatment response in MMT, but not in HAT. The latter was probably due to the strong reduction in illicit heroin use in most patients in HAT and the small sample size of the sub-study. It is hypothesized that the strong reductions in craving for heroin in HAT are related to the stable availability of prescribed, pharmaceutical grade heroin. (C) 2011 Elsevier Ireland Ltd. All rights reserved