Background: Heroin-assisted treatment (HAT) can improve the condition of heroin addicts resistant to other treatment. A new trial compared HAT and methadone treatment with HAT limited to 12 months in order to assess its feasibility and efficacy in Belgium. Methods: TADAM (Treatment Assisted by Diacetylmorphine) was an open label randomised controlled trial. The experimental treatment was based upon the Swiss model of HAT developed in 1994. The primary efficacy criterion was determined by an improvement in street heroin use or in (physical or mental) health or a decrease in criminal involvement. Participants were assessed every 3 months. Self-reported data were complemented with toxicological analyses and criminal proceedings. Findings: 74 participants were randomised in the trial: 36 in the experimental group and 38 in the control group. The experimental group counted 30% of responders more than the control group at 3 months (p<0.05), 6 months (p<0.05), and 9 months (p<0.01). At 12 months, the number of responders was still higher in the experimental group (11%) but the difference was no longer significant (p=0.35). Street heroin use increased in the experimental group at the 12-month assessment just before the end of HAT. Conclusion: HAT is feasible and effective. However, HAT should not have a predetermined duration for heroin users for which heroin addiction became a chronic relapsing disease. Other data: In addition to the outcomes of the randomised controlled trial, the report contains other exploratory data and analysis: satisfaction of in treatment, criminological data, opinion of heroin users not included in the trial, opinion of caregivers and field workers (in the HAT centre, in the partner centres, and in other centres in the addiction field), impact of the HAT centre on its neighbourhood and a socio-economic evaluation. Funding: The TADAM trial was funded at 80% by the Federal Minister of Social Affairs and Public Health. It was also funded the City and the University of Liège. ; Een vertaling in het Nederlands van het document met de samenvattingen is hieronder beschikbaar.
Nous présenterons tout d'abord une mise au point sur les tendances actuelles, les évolutions dans les demandes, les thérapies et l'organisation des soins. Nous tenterons de répondre aux questions : pourquoi un réseau ? Un réseau en santé mental est-il possible au vue de la diversité de l'offre de soins ? Faut-il aiguiser sa différence et renforcer les particularités de chaque courant ou faut-il conjuguer des modalités cliniques différentes ? Nous envisagerons ensuite la place de l'hôpital de jour du centre universitaire provincial "La Clairière" dans le réseau de santé mentale de la province du Luxembourg, région rurale avec une population peu nombreuse et dispersée. Enfin, nous aborderons quelques réflexions suscitées par l'évolution de la politique de soins en santé mentale. Derrière des idées d'optimisation des ressources, d'efficience et de qualité, ne se cache-t-il pas une notion de gestion de l'humain ? ; Peer reviewed
<b><i>Background/Aims:</i></b> Heroin-assisted treatment (HAT) can improve the condition of heroin addicts still using street heroin after a methadone treatment. In Belgium, a new trial compared the efficacy of a HAT to existing methadone maintenance treatment. <b><i>Methods:</i></b> In this randomised controlled trial, HAT was limited to 12 months. Participants were assessed every 3 months. They were responders if they showed improvement on the level of street heroin use, health or criminal involvement. <b><i>Results:</i></b> 74 participants were randomised in the trial. The experimental group (n = 36) counted 30% of responders more than the control group (n = 38) at each assessment point (p < 0.05), except at 12 months where the difference (11%) was no longer significant (p = 0.35). Still, after 12 months, participants in the experimental group reported significantly greater improvements (p < 0.05) than the control group on the level of street heroin use and on the level of physical and mental health. Both groups reported significantly less criminal acts after 12 months (p < 0.001), but with no significant difference between the groups. <b><i>Conclusions:</i></b> This trial confirms the short-term efficacy of HAT for severe heroin addicts, who already failed methadone treatment.
Background/Aims: Heroin-assisted treatment (HAT) can improve the condition of heroin addicts still using street heroin after a methadone treatment. In Belgium, a new trial compared the efficacy of a HAT to existing methadone maintenance treatment. Methods: In this randomised controlled trial, HAT was limited to 12 months. Participants were assessed every 3 months. They were responders if they showed improvement on the level of street heroin use, health or criminal involvement. Results: 74 participants were randomised in the trial. The experimental group (n=36) counted 30% of responders more than the control group (n=38) at each assessment point (p<0.05), except at 12 months where the difference (11%) was no longer significant (p=0.35). Still, after 12 months, participants in the experimental group reported significantly greater improvements (p<0.05) than the control group on the level of street heroin use and on the level of physical and mental health. Both groups reported significantly less criminal facts after 12 months (p<0.001), but with no significant difference between the groups. Conclusions: This trial confirms the short-term efficacy of HAT for severe heroin addicts, who already failed methadone treatment. ; Peer reviewed
