Comment: The quality of evidence is downgraded by study limitations (unclear blinding in half of the studies).
A Cochrane review included 8 studies with a total of 2007 subjects. Supervised injected heroin plus flexible dosages of methadone helped patients to remain in treatment compared to oral methadone only (RR 1.44, 95% CI 1.19 to 1.75; 4 trials, n=1388), and to reduce use of illicit drugs. Maintenance with supervised injected heroin has statistically nonsignificant protective effect on mortality (RR 0.65, 95% CI 0.25 to 1.69, 4 trials, n=1477) but it exposes at a greater risk of adverse events related to study medication (RR 13.50, 95% CI 2.55 to 71.53; 3 trials, n=373). Results on criminal activity and incarceration were not possible to be pooled but where this outcome was measured results of single studies do provide evidence that heroin provision can reduce criminal activity. Social functioning improved in all the intervention groups with heroin groups having slightly better results.
Date of latest search: 5 January 2011