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Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with\n SIH<\/jats:styled-content>\n . We now examine secondary outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n \n Multi\u2010site randomized controlled trial (\n RCT)<\/jats:styled-content>\n comparing\n SIH<\/jats:styled-content>\n versus\n OOM<\/jats:styled-content>\n and\n SIM<\/jats:styled-content>\n versus\n OOM<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n \n Three supervised injectable opiate clinics in\n E<\/jats:styled-content>\n ngland.\n <\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n \n Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment (\n n<\/jats:italic>\n \u2009=\u2009127), randomized to either\n SIH<\/jats:styled-content>\n (\n n<\/jats:italic>\n \u2009=\u200943),\n SIM<\/jats:styled-content>\n (\n n<\/jats:italic>\n \u2009=\u200942) or\n OOM<\/jats:styled-content>\n (\n n<\/jats:italic>\n \u2009=\u200942). All received high levels of medical and psychosocial support.\n <\/jats:p>\n <\/jats:sec>\n \n Measurements<\/jats:title>\n Secondary outcomes: wider drug use, crime, health and social functioning at 6 months.<\/jats:p>\n <\/jats:sec>\n \n Findings<\/jats:title>\n \n A<\/jats:styled-content>\n t 6 months, no significant differences were found between treatment groups in wider drug use (crack\/cocaine, benzodiazepines, alcohol), physical and mental health (\n SF<\/jats:styled-content>\n \u201036) or social functioning. Within each treatment group, significant reductions were observed in crime [\n SIH<\/jats:styled-content>\n \u2009=\u2009odds ratio (\n OR)<\/jats:styled-content>\n 0.05;\n P<\/jats:italic>\n \u2009<\u20090.001;\n SIM<\/jats:styled-content>\n \u2009=\u2009\n OR<\/jats:styled-content>\n 0.11;\n P<\/jats:italic>\n \u2009=\u20090.002;\n OOM<\/jats:styled-content>\n \u2009=\u2009\n OR<\/jats:styled-content>\n 0.11;\n P<\/jats:italic>\n \u2009=\u20090.003] and money spent per week on illicit drugs (\n SIH<\/jats:styled-content>\n \u2009=\u2009mean change \u00a3\u2013289.43;\n P<\/jats:italic>\n \u2009<\u20090.001;\n SIM<\/jats:styled-content>\n \u2009=\u2009mean change \u00a3\u2013183.41;\n P<\/jats:italic>\n \u2009<\u20090.001;\n OOM<\/jats:styled-content>\n \u2009=\u2009mean change \u00a3\u2013162.80;\n P<\/jats:italic>\n \u2009<\u20090.001), with\n SIH<\/jats:styled-content>\n significantly more likely to have reduced money spent on illicit drugs versus\n OOM<\/jats:styled-content>\n (mean difference \u00a3\u201392.04;\n P<\/jats:italic>\n \u2009<\u20090.001). Significant improvements were seen in physical health for\n SIH<\/jats:styled-content>\n and\n SIM<\/jats:styled-content>\n (\n SIH<\/jats:styled-content>\n \u2009=\u2009mean change 3.97;\n P<\/jats:italic>\n \u2009=\u20090.008; SIM\u2009=\u2009mean change 4.73;\n P<\/jats:italic>\n \u2009=\u20090.002) and mental health for\n OOM<\/jats:styled-content>\n (mean change 6.04;\n P<\/jats:italic>\n \u2009=\u20090.013).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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\u2010month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/add.12748","type":"journal-article","created":{"date-parts":[[2014,9,23]],"date-time":"2014-09-23T03:29:25Z","timestamp":1411442965000},"page":"479-490","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Drug use, health and social outcomes of hard\u2010to\u2010treat heroin addicts receiving supervised injectable opiate treatment: secondary outcomes from the\n R<\/scp>\n andomized\n I<\/scp>\n njectable\n O<\/scp>\n pioid\n T<\/scp>\n reatment\n T<\/scp>\n rial (\n RIOTT<\/scp>\n )"],"prefix":"10.1111","volume":"110","author":[{"given":"Nicola","family":"Metrebian","sequence":"first","affiliation":[{"name":"Addictions Department Institute of Psychiatry Psychology and Neuroscience Kings College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora","family":"Groshkova","sequence":"additional","affiliation":[{"name":"European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Hellier","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Institute of Psychiatry Psychology and Neuroscience Kings College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikki","family":"Charles","sequence":"additional","affiliation":[{"name":"Addictions Department Institute of Psychiatry Psychology and Neuroscience Kings College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthea","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Institute of Psychiatry Psychology and Neuroscience Kings College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana","family":"Forzisi","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Institute of Psychiatry Psychology and Neuroscience Kings College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Lintzeris","sequence":"additional","affiliation":[{"name":"The Langton Centre Drug and Alcohol Services South East Sydney Local Health District and Division of Addiction Medicine Sydney University Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Zador","sequence":"additional","affiliation":[{"name":"Justice Health and Forensic Mental Health Network NSW Ministry of Health Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugh","family":"Williams","sequence":"additional","affiliation":[{"name":"Sussex Partnership NHS Trust West Sussex UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Carnwath","sequence":"additional","affiliation":[{"name":"Atkinson Lewis Ltd Swansea UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soraya","family":"Mayet","sequence":"additional","affiliation":[{"name":"Tees, Esk and Wear Valleys, NHS Foundation Trust Durham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Strang","sequence":"additional","affiliation":[{"name":"Addictions Department Institute of Psychiatry Psychology and Neuroscience Kings College London London UK"},{"name":"South London and Maudsley NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,11,7]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Department of Health National Treatment Agency for Substance Misuse.2012.Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2011\u201331 March 2012. 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