Heroin or conventional opioid maintenance? The patients' perspective

OBJECTIVE: This study focused on the question whether patients with conventional opioid maintenance treatment (COMT) would prefer a switch to heroin maintenance treatment (HMT).

METHODS: We performed a region-wide anonymous survey of patients in the opioid maintenance program in Berlin, Germany. All 20 psychiatric hospitals and all 110 physicians' practices in Berlin licensed to offer COMT were approached to reach patients under COMT and also fulfilling the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria of opiate dependence. The anonymous questionnaire focused on the question whether patients would prefer HMT to COMT. In our study, 986 of 5032 patients (19.6%) with COMT in Berlin participated. Of them, 881 (89.4%) patients gave information whether they would prefer HMT to COMT.

RESULTS: Of the participating patients, 40.9% would prefer HMT to COMT. These patients report more detoxification therapies (P < 0.001), a higher dose of methadone equivalent (P = 0.001), and more often continued use of multiple illegal drugs despite COMT (P < 0.001) than patients not preferring HMT. They also report less improvement in mental health (P < 0.001) and working abilities (P < 0.001) because of COMT than patients not preferring HMT.

CONCLUSIONS: The data on the patients' perspective complement the existing clinical studies, showing that previously unresponsive opioid-addicted patients especially would switch to HMT, whereas most patients would prefer continuation of COMT.