Drug use, health and social outcomes of hard-to-treat heroin addicts receiving supervised injectable opiate treatment: secondary outcomes from the Randomized Injectable Opioid Treatment Trial (RIOTT)

Abstract

Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes.

Commentary on Metrebian et al (2015): What is addiction treatment research about? Some comments on the secondary outcomes of the Randomized Injectable Opioid Treatment Trial

“…The Randomized Injectable Opioid Treatment Trial (RIOTT) paper [1] presents detailed findings on health and social change under the heading of secondary outcomes. The reduction of substance use is considered the primary goal of interventions.…”

“…The German trial had an entry criterion of 'poor physical and/or mental health with at least 13 symptoms on the Opiate Treatment Index OTI' [9], and the Dutch trials had an entry criterion of 'poor physical or mental health', including those not stabilized on psychiatric medication [10], while in RIOTT any 'active significant medical or psychiatric condition' was excluded [11]. Participants were recruited from methadone programmes [1,10], but also from the street being out of treatment [9,12,13]. The following instruments for initial assessments were used: DSM-IV [10], Symptom Checklist Index-90 (SCL-90) [10], SCL-90-R [9], Opiate Treatment Index (OTI) [9,12], Short Form (SF)-12 [12], Addiction Severity Index (ASI) [12], Europ-ASI [13] and the SF Health Survey [14], plus diverse laboratory data.…”

“…This is an invitation to improve concept and practice of clinics and other providers. Upscaling HAT for patients failing in OMM is suggested by a better reduction in crime [1], accounting for lower costs when compared to OOM [18]. Policy should also include decisions about where the priorities for treatment goals and evaluation of outcomes are, in response to the main problems in a given country [19].…”

“…The paper by Metrebian et al [1] offers an excellent opportunity to discuss some major issues of addiction treatment research. First, the traditional hierarchy of treatment goals in the addiction field neglects the causal and modifying role of health and social factors on addictive behaviour, suggesting replacing the reduction of substance use by an individualized quality of life as the ultimate goal.…”

Addictions. Substance addictions vs. behavioural addictions

“…Addictions in contemporary society present an increasingly significant problem [1,2,3,], which can negatively influence the personality [4,5,6], general health status of affected individuals [7,8,9], functioning of families [10,11] and other social groups [12,13].…”