Patients prescribed injectable heroin or methadone - their opinions and experiences of treatment

Aims : To describe the opinions and experiences of treatment of a cohort of patients prescribed injectable opiate treatment (IOT).
Design, setting, participants : Cross-sectional survey of all patients on injectable diamorphine or methadone at a tertiary referral clinic in the northwest of England in June 2000.
Findings : A total of 104 subjects were prescribed IOT, mostly male (87.5%) and with a mean age of 36,3 years (SEM 0.66, range 20-53). The majority (75.0%) were prescribed injectable methadone with the remainder (25.0%) on injectable diamorphine. Most subjects (93.3%) used intravenously many (58.7%) into the femoral vein. Treatment was sought most frequently in order to procure a drug supply of known dose and purity to improve family relationships and to avoid trouble with the police. Half were satisfied with their treatment but many wanted to change to injectable diamorphine or to increase their doses. Subjects cited many advantages of injectable diamorphine over injectable methadone, although benefits of injectable methadone were acknowledged.
Conclusions : Subjects articulated a consistent desire for IOT in order to 'stabilize' their lives in a number of ways. This sample was recruited from one of the country's largest specialist IOT clinics. The generalizability of this study's findings to all patients in the United Kingdom currently prescribed IOT, however, was not examined. Nevertheless, these findings suggest that clinicians and policy makers should be aware of many heroin users' perception of IOT as long-term treatment and their clear preference for injectable diamorphine. Further investigation of differential outcomes between oral and injectable OT and between different injectable opiates is warranted. (Review' s abstract)