Prescribing drug of choice to illicit heroin users : the experience of UK community drug team

FRANÇAIS :
Cette étude évalue la prescription de diamorphine injectable (forme pharmaceutique de l'héroïne) à des usagers d'héroïne illicite, comme complément de traitement dans un centre pour toxicomanes; le groupe de comparaison se compose de patients sous méthadone. Moins de psychopathologies et une plus grande durée du traitement ont été observées chez le groupe "diamorphine. Moins important, l'usage d'héroïne illicite n'a pas pour autant disparu ; l'usage d'autres substances illicites est comparable dans les deux groupes, mais l'usage de cocaïne illicite est plus important chez les "diamorphine". Bien qu'aucune différence de santé physique n'apparaisse, le partage de seringues usagées s'observe uniquement chez les "méthadone". La délinquance semble diminuée mais pas éliminée chez les "diamorphine". Les implications pour les méthodes de prescription sont examinées.
ENGLISH :
Functioning across several life domains, in the first cohort of illicit heroin users to be prescribed injectable diamorphine (pharmaceutical heroin) as an adjunct to treatment within a community drugs service, was assessed in a cross-sectional study with a 6-month follow-up. Case-control matching procedures were employed to compare outcomes in this group with an oral methadone-prescribed (MP) sample, attending different clinics within the same community service and geographical locale. The Heroin Prescribed (HP) group manifested lower levels of psychopathology and showed greater retention in treatment. Although reduced, illicit heroin misuse was not eliminated ; the use of other illicit substances was comparable between groups but significantly more of the HP group were using illicit cocaine. Although no differences in current physical health were apparent, the sharing of used injecting equipment was reported only in the MP group. Criminal activity appeared significantly reduced, but not eliminate, in the HP group. Implications for prescribing practice are discussed. (Authors'abstract)