Centre for the Economics of Mental Health (CEMH)
The main measure of effectiveness will be the proportion of participants who stop using illicit heroin. Laboratory urine tests allow researchers to check if heroin used is prescribed by the clinics or has come from the streets.
Researchers will also be collecting information about other illicit drug use, injecting behaviour, health and social functioning, criminal activity and patient satisfaction when participants join the trial and then at three months and at six months.
Injected opioid treatment is likely to be more expensive than optimised oral methadone treatment, yet may be more effective and produce cost savings elsewhere. An economic evaluation will explore cost-effectiveness by calculating the costs of the three treatments and all other health, social and voluntary sector services, as well as criminal justice sector costs, the cost of crime and the cost of days off work due to illness.
The research component of the trial is funded by a research grant from the charity Action on Addiction and by the Big Lottery. Clinical services, including the establishment of new supervised injecting clinics, were funded by the Home Office, the National Treatment Agency and local authorities.
s.byford@iop.kcl.ac.uk
Trial co-ordinator Nicky Metrebian
nicola.metrebian@iop.kcl.ac.uk
Randomised Injecting Opioid Treatment Trial (RIOTT): Evaluation of injectable methadone and heroin treatment in the UK
Summary
This study is a multi-centre randomised controlled trial that examines the effectiveness and cost-effectiveness of treatment with injected opioids (methadone and heroin) for patients who are dependent on heroin but do not respond to conventional methadone substitution treatment. The study examines whether efforts should be made to optimise conventional treatment for such patients (eg regular attendance, supervised dosing, high oral methadone doses, access to psychosocial services) or whether such patients should be treated with injected methadone or heroin.Why carry out the research?
Conventional substitution programmes using methadone are effective for most heroin users entering treatment. However, there is a proportion of patients who do not benefit from oral methadone. One alternative for this group is the prescription of injectable opioids – methadone and diamorphine (pharmaceutical heroin). Research is required to examine whether the prescribing of injectable opioids is more effective and more cost-effective than attempts to enhance oral methadone treatment for patients who do not respond to existing treatment.How is the research being undertaken?
150 people in oral methadone substitution treatment and injecting illicit heroin on a regular basis are being recruited to the trial. 50 of them will be provided with optimised methadone medicine to take orally. 50 will be given supervised injected long-acting methadone treatment and the remaining 50 will be given supervised injected heroin (with access to doses of oral methadone). All participants will be followed up for six months to enable researchers to compare the effectiveness and cost-effectiveness of the three treatments.The main measure of effectiveness will be the proportion of participants who stop using illicit heroin. Laboratory urine tests allow researchers to check if heroin used is prescribed by the clinics or has come from the streets.
Researchers will also be collecting information about other illicit drug use, injecting behaviour, health and social functioning, criminal activity and patient satisfaction when participants join the trial and then at three months and at six months.
Injected opioid treatment is likely to be more expensive than optimised oral methadone treatment, yet may be more effective and produce cost savings elsewhere. An economic evaluation will explore cost-effectiveness by calculating the costs of the three treatments and all other health, social and voluntary sector services, as well as criminal justice sector costs, the cost of crime and the cost of days off work due to illness.
Where is it happening?
The study is taking place in London (two sites), Brighton and Darlington. New supervised injecting clinics have been set up at each site.Who is involved?
Professor John Strang, Director of the National Addiction Centre at the IoP is one of the principal investigators. The economic evaluation is being carried out by the Centre for the Economics of Mental Health.The research component of the trial is funded by a research grant from the charity Action on Addiction and by the Big Lottery. Clinical services, including the establishment of new supervised injecting clinics, were funded by the Home Office, the National Treatment Agency and local authorities.
What is the timescale?
The trial will run for three and a half years until May 2008. If early indications are positive, the treatment clinics will remain open at the trial end for those receiving the injectable heroin and methadone treatments.To find out more
Sarah Byford, Centre for the Economics of Mental Healths.byford@iop.kcl.ac.uk
Trial co-ordinator Nicky Metrebian
nicola.metrebian@iop.kcl.ac.uk