***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Heroin-assisted treatment has been found to be effective for people with severe opioid dependence who are not interested in or do poorly on methadone maintenance . AIMS To study heroin-assisted treatment in people on methadone who continue intravenous heroin and in those who are heroin dependent but currently not in treatment . METHOD In an open-label multicentre r and omised controlled trial , 1015 people with heroin dependence received a variable dose of injectable heroin ( n=515 ) or oral methadone ( n=500 ) for 12 months . Two response criteria , improvement of physical and /or mental health and decrease in illicit drug use , were evaluated in an intent-to-treat analysis . RESULTS Retention was higher in the heroin ( 67.2 % ) than in the methadone group ( 40.0 % ) and the heroin group showed a significantly greater response on both primary outcome measures . More serious adverse events were found in the heroin group , and were mainly associated with intravenous use . CONCLUSIONS Heroin-assisted treatment is more effective for people with opioid dependence who continue intravenous heroin while on methadone maintenance or who are not enrolled in treatment . Despite a higher risk , it should be considered for treatment resistance under medical supervision Abstract Objective : To evaluate an experimental heroin maintenance programme . Design : R and omised trial . Setting : Outpatient clinic in Geneva , Switzerl and . Subjects : Heroin addicts recruited from the community who were socially marginalised and in poor health and had failed in at least two previous drug treatments . Intervention : Patients in the experimental programme ( n=27 ) received intravenous heroin and other health and psychosocial services .  Control patients ( n=24 ) received any other conventional drug treatment ( usually methadone maintenance ) . Main outcome measures : Self reported drug use , health status ( SF-36 ) , and social functioning . Results : 25 experimental patients completed 6 months in the programme , receiving a median of 480 mg of heroin daily . One experimental subject and 10 control subjects still used street heroin daily at follow up ( difference 44 % ; 95 % confidence interval 16 % to 71 % ) . Health status scores that improved significantly more in experimental subjects were mental health ( 0.58 SD ; 0.07 to 1.10 ) , role limitations due to emotional problems ( 0.95 SD ; 0.11 to 1.79 ) , and social functioning ( 0.65 SD ; 0.03 to 1.26 ) . Experimental subjects also significantly reduced their illegal income and drug expenses and committed fewer drug and property related offences . There were no benefits in terms of work , housing situation , somatic health status , and use of other drugs . Unexpectedly , only nine ( 38 % ) control subjects entered the heroin maintenance programme at follow up . Conclusions : A heroin maintenance programme is a feasible and clinical ly effective treatment for heroin users who fail in conventional drug treatment programmes . Even in this population , however , another attempt at methadone maintenance may be successful and help the patient to stop using injectable opioids The effects of maintenance on a narcotic antagonist , naltrexone ( 50 mg/day p.o . ) , or placebo on patterns of operant acquisition and use of heroin were studied under double-blind conditions . Twelve male heroin addict volunteers lived on a clinical research ward for 34 days . After a 9 day drug-free period , naltrexone or placebo were given and heroin ) 40 mg/day ) was available for 10 days . Subjects could earn money ( $ 1.50 ) or heroin ( 10 mg i.v . ) by responding on a second-order schedule of reinforcement [ FR 300 ( FI 1 sec : S ) ] for approximately 90 min . The three naltrexone-maintained subjects took only 2 to 7.5 % of the total heroin available . Two naltrexone subjects stopped heroin self-administration after the 1st or 2nd heroin injection ; the third subject took a 3rd heroin injection on the 8th day of heroin availability . Naltrexone maintenance for 25 consecutive days did not produce adverse side effects . In contrast , the nine placebo naltrexone subjects used 57.5 to 100 % of the total heroin available . Five placebo subjects used all or all but one of the 40 injections available ; four placebo subjects often used less heroin than was available each day . Heroin intoxication did not impair operant performance . Heroin users worked longer hours and earned more purchase points ( P < .05 ) during heroin self-administration and subsequent methadone detoxification than during the drug-free period . Subjects precisely titrated operant work to acquire the desired amount of heroin , then resumed working for money . These data demonstrate the feasibility of using direct measures of drug self-administration behavior to evaluate new pharmacotherapies for heroin abuse and indicate the effectiveness of naltrexone in suppressing heroin self-administration Abstract Objective To determine whether supervised medical prescription of heroin can successfully treat addicts who do not sufficiently benefit from methadone maintenance treatment .  Design Two open label r and omised controlled trials . Setting Methadone maintenance programmes in six cities in the Netherl and s. Participants 549 heroin addicts . Interventions Inhalable heroin ( n = 375 ) or injectable heroin ( n = 174 ) prescribed over 12 months . Heroin ( maximum 1000 mg per day ) plus methadone ( maximum 150 mg per day ) compared with methadone alone ( maximum 150 mg per day ) . Psychosocial treatment was offered throughout . Main outcome measures Dichotomous , multidomain response index , including vali date d indicators of physical health , mental status , and social functioning . Results Adherence was excellent with 12 month outcome data available for 94 % of the r and omised participants . With intention to treat analysis , 12 month treatment with heroin plus methadone was significantly more effective than treatment with methadone alone in the trial of inhalable heroin ( response rate 49.7 % v 26.9 % ; difference 22.8 % , 95 % confidence interval 11.0 % to 34.6 % ) and in the trial of injectable heroin ( 55.5 % v 31.2 % ; difference 24.3 % , 9.6 % to 39.0 % ) . Discontinuation of the coprescribed heroin result ed in a rapid deterioration in 82 % ( 94/115 ) of those who responded to the coprescribed heroin . The incidence of serious adverse events was similar across treatment conditions . Conclusions Supervised coprescription of heroin is feasible , more effective , and probably as safe as methadone alone in reducing the many physical , mental , and social problems of treatment resistant heroin addicts Background The objective of this research was to evaluate data from a r and omized clinical trial that tested injectable diacetylmorphine ( DAM ) and oral methadone ( MMT ) for substitution treatment , using a multi-domain dichotomous index , with a Bayesian approach . Methods Sixty two long-term , socially-excluded heroin injectors , not benefiting from available treatments were r and omized to receive either DAM or MMT for 9 months in Granada , Spain . Completers were 44 and data at the end of the study period was obtained for 50 . Participants were determined to be responders or non responders using a multi-domain outcome index accounting for their physical and mental health and psychosocial integration , used in a previous trial . Data was analyzed with Bayesian methods , using information from a similar study conducted in The Netherl and s to select a priori distributions . On adding the data from the present study to up date the a priori information , the distribution of the difference in response rates were obtained and used to build credibility intervals and relevant probability computations . Results In the experimental group ( n = 27 ) , the rate of responders to treatment was 70.4 % ( 95 % CI 53.2 - 87.6 ) , and in the control group ( n = 23 ) , it was 34.8 % ( 95 % CI 15.3 - 54.3 ) . The probability of success in the experimental group using the a posteriori distributions was higher after a proper sensitivity analysis . Almost the whole distribution of the rates difference ( the one for diacetylmorphine minus methadone ) was located to the right of the zero , indicating the superiority of the experimental treatment . Conclusion The present analysis suggests a clinical superiority of injectable diacetylmorphine compared to oral methadone in the treatment of severely affected heroin injectors not benefiting sufficiently from the available treatments . Trial Registration Current Controlled Trials IS RCT Whilst unsupervised injectable methadone and diamorphine treatment has been part of the British treatment system for decades , the numbers receiving  injectable opioid treatment ( IOT ) has been steadily diminishing in recent years . In contrast , there has been a recent expansion of supervised injectable diamorphine programs under trial conditions in a number of European and North American cities , although the evidence regarding the safety , efficacy and cost effectiveness of this treatment approach remains equivocal . Recent British clinical guidance indicates that IOT should be a second-line treatment for those patients in high- quality oral methadone treatment who continue to regularly inject heroin , and that treatment be initiated in newly-developed supervised injecting clinics . The R and omised Injectable Opioid Treatment Trial ( RIOTT ) is a multisite , prospect i ve open-label r and omised controlled trial ( RCT ) examining the role of treatment with injected opioids ( methadone and heroin ) for the management of heroin dependence in patients not responding to conventional substitution treatment . Specifically , the study examines whether efforts should be made to optimise methadone treatment for such patients ( e.g. regular attendance , supervised dosing , high oral doses , access to psychosocial services ) , or whether such patients should be treated with injected methadone or heroin .  Eligible patients ( in oral substitution treatment and injecting illicit heroin on a regular basis ) are r and omised to one of three conditions : ( 1 ) optimized oral methadone treatment ( Control group ) ; ( 2 ) injected methadone treatment ; or ( 3 ) injected heroin treatment ( with access to oral methadone doses ) . Subjects are followed up for 6-months , with between-group comparisons on an intention-to-treat basis across a range of outcome measures . The primary outcome is the proportion of patients who discontinue regular illicit heroin use ( operationalised as providing > 50 % urine drug screens negative for markers of illicit heroin in months 4 to 6 ) . Secondary outcomes include measures of other drug use , injecting practice s , health and psychosocial functioning , criminal activity , patient satisfaction and incremental cost effectiveness . The study aims to recruit 150 subjects , with 50 patients per group , and is to be conducted in supervised injecting clinics across Engl and Ninety-six confirmed heroin addicts requesting a heroin maintenance prescription were r and omly allocated to treatment with injectable heroin or oral methadone . Progress was monitored throughout the next 12 months by research workers operating independently of the clinic . Heroin can be seen as maintaining the status quo , with the majority continuing to inject heroin regularly and to supplement their maintenance prescription from other sources ; it was associated with a continuing intermediate level of involvement with the drug subculture and criminal activity . Refusal to prescribe heroin while offering oral methadone constituted a more confrontational response and result ed in a higher abstinence rate , but also a greater dependence on illegal sources of drugs for these who continued to inject . Those offered oral methadone tended to polarize toward high or low categories of illegal drug use and involvement with the drug subculture , and were more likely to be arrested during the 12-month follow-up . There was no difference between the two groups in terms of employment , health , or consumption of nonopiate drugs . Refusal to prescribe heroin result ed in a significantly greater drop out from regular treatment Data from a seven-year follow-up study of heroin addicts were analysed to show group trends . Time spent in various activities was quantified for each person for each year of the follow-up period and used to provide a composite life history . Time spent by the sample using drugs has decreased over the follow-up period . The most marked decrease appeared in the use of heroin , but the analysis suggests that a hard core of heroin users still used heroin several years after coming to the clinic . There seems to be an overall congruence between abstinence and non-clinic attendance . For this sample the use of illegal opiates without attending a clinic was relatively rare , and total time spent in hospitals and in prisons was rather small . Death occurred r and omly during the follow-up period AIMS To investigate whether the neonatal abstinence syndrome ( NAS ) is different in children born to women maintained on slow-release morphine  , compared with those maintained on methadone  , and to compare additional drug consumption in these groups of women . DESIGN , SETTING AND PARTICIPANTS An open , r and omized trial was conducted in an established clinic . Forty-eight pregnant women who presented to the clinic as opiate or polysubstance abusers were enrolled and maintained on either methadone ( 24 women ) or slow-release morphine ( 24 women ) up to and following delivery . The programme included psychosocial therapy and support for their opiate-addicted partners . MEASUREMENTS St and ard urinalysis methods were used to measure consumption of cocaine and benzodiazepines during pregnancy . Injection sites were monitored to indicate additional opiate use . NAS was measured according to Finnegan score and the amount of phenobarbiturates prescribed to alleviate the symptoms . FINDINGS No difference was found in the number of days that NAS was experienced by neonates born to methadone or morphine maintained mothers ( mean = 16 and 21 days , respectively ) . All children were born healthy and no serious complications arose . Fewer benzodiazepines ( p < 0.05 
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Results on criminal activity and incarceration were not possible to be pooled but where the outcome were measured results of single studies do provide evidence that heroin provision can reduce criminal activity and incarceration/imprisonment .
Social functioning improved in all the intervention groups with heroin groups having slightly better results .
If all the studies comparing heroin provision in any conditions vs any other treatment are pooled the direction of effect remain in favour of heroin .
AUTHORS ' CONCLUSIONS The available evidence suggests an added value of heroin prescribed alongside flexible doses of methadone for long-term , treatment refractory , opioid users , to reach a decrease in the use of illicit substances , involvement in criminal activity and incarceration , a possible reduction in mortaliity ; and an increase in retention in treatment .