***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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    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 AIM Supervised consumption of opioid maintenance treatment ( OMT ) is st and ard in many drug centres reducing drug diversion , but is costly . We aim ed to determine whether supervised consumption of OMT improved retention and other measures of drug use . DESIGN Pragmatic r and omized controlled trial comparing 3 months of daily supervised consumption of OMT with 1 month or less of daily supervised OMT , then daily unsupervised consumption . SETTING Four community drug services in the United Kingdom . PARTICIPANTS A total of 293 opioid-dependent patients entering OMT . MEASUREMENTS PRIMARY OUTCOME retention in treatment at 12 weeks . Secondary : retention at 6 months ; illicit drug use [ Maudsley Addiction Profile ( MAP ) ] ; quality of life ( SF-12 and MAP ) ; criminality ( MAP ) ; and social functioning . FINDINGS No significant between-group difference was observed for the primary outcome : 69 % ( 100 of 145 ) supervised and 74 % ( 109 of 148 ) unsupervised were retained [ odds ratio ( OR ) = 0.74 , 95 % confidence interval ( CI ) = 0.43 - 1.27 ] . Per protocol survival analysis suggested that supervised patients were less well retained ( hazard ratio for retention = 0.71 , 95 % CI = 0.51 - 1.00 ) . Illicit opioid use reduced in both groups and , while not statistically significant by intention-to-treat analysis , favoured unsupervised patients in per protocol analysis ( odds of positive opioid screen for supervised versus unsupervised = 2.07 , 95 % CI = 1.05 - 4.06 ) . Data on criminal activity also favoured unsupervised patients with 21 % supervised patients committing crime versus 9 % unsupervised ( OR = 3.37 , 95 % CI = 1.28 - 8.86 ) . CONCLUSIONS There was no evidence of a difference in treatment retention or opioid use rates between patients whose consumption of opioid maintenance treatment was supervised for 3 months daily ( except Saturdays ) compared with supervision for 1 month . There was some evidence that longer periods of supervised consumption were associated with higher levels of criminality BACKGROUND The partial opiate-receptor agonist buprenorphine has been suggested for treatment of heroin dependence , but there are few long-term and placebo-controlled studies of its effectiveness . We aim ed to assess the 1-year efficacy of buprenorphine in combination with intensive psychosocial therapy for treatment of heroin dependence . METHODS 40 individuals aged older than 20 years , who met DSM-IV criteria for opiate dependence for at least 1 year , but did not fulfil Swedish legal criteria for methadone maintenance treatment were r and omly allocated either to daily buprenorphine ( fixed dose 16 mg sublingually for 12 months ; supervised daily administration for a least 6 months , possible take-home doses thereafter ) or a tapered 6 day regimen of buprenorphine , thereafter followed by placebo . All patients participated in cognitive-behavioural group therapy to prevent relapse , received weekly individual counselling sessions , and su bmi tted thrice weekly supervised urine sample s for analysis to detect illicit drug use . Our primary endpoint was 1-year retention in treatment and analysis was by intention to treat . FINDINGS 1-year retention in treatment was 75 % and 0 % in the buprenorphine and placebo groups , respectively ( p=0.0001 ; risk ratio 58.7 [ 95 % CI 7.4 - 467.4 ] ) . Urine screens were about 75 % negative for illicit opiates , central stimulants , cannabinoids , and benzodiazepines in the patients remaining in treatment . INTERPRETATION The combination of buprenorphine and intensive psychosocial treatment is safe and highly efficacious , and should be added to the treatment options available for individuals who are dependent on heroin BACKGROUND The registration of combination buprenorphine/naloxone , a formulation design ed to reduce risk of diversion , has led some Australian jurisdictional authorities to allow treatment without direct observation of dosing for stable , opioid-dependent patients . AIM To compare two approaches ( 1 ) initiating treatment with observed dosing , then allowing patients who demonstrate stability to change to unobserved dosing ; or ( 2 ) initiating patients with unobserved dosing , subsequently requiring those who fail to stabilize to change to observed treatment . METHODS This study builds on an RCT comparing efficacy of observed and unobserved treatment at 3 months . At the conclusion of the RCT , clinical ly " stable " subjects were allocated to continue without observed dosing , while those who did not demonstrate stability were allocated to observed dosing . Subjects were followed for a further 3 months . Primary end-point was retention in treatment . RESULTS Of 119 subjects r and omised , 70 were retained in treatment to 3 months . Forty-five stable subjects were allocated to unobserved dosing , 25 to observation . Unstable subjects allocated to observed treatment were more likely to drop out thereafter ( OR 2.14 , 95 % CI 1.09 - 4.19 ) . There was a non-significant trend for people initiated with observed dosing to be better retained during the allocation phase ; at 6 months , 13 subjects ( 22 % ) from the original unobserved group , and 22 ( 34 % ) from the observed group , were retained in treatment ( chi2=2.10 , 1 df , p=0.15 ) . CONCLUSIONS Withdrawal of unobserved doses led to marked attrition from treatment . If access to unobserved dosing is to be restricted to stable patients , it appears preferable to initiate dosing with observation and allow unobserved doses for people who successfully stabilize , than to initiate with unobserved doses and transfer unstable patients to observation AIMS This study aim ed to determine the relative effectiveness of 12 months of interim methadone ( IM ; supervised methadone with emergency counseling only for the first 4 months of treatment ) , st and ard methadone treatment ( SM ; with routine counseling ) and restored methadone treatment ( RM : routine counseling with smaller case-loads ) . DESIGN A r and omized controlled trial was conducted comparing IM , SM and RM treatment . IM lasted for 4 months , after which participants were transferred to SM . SETTING The study was conducted in two methadone treatment programs in Baltimore , MD , USA . PARTICIPANTS The study included 230 adult methadone patients newly admitted through waiting-lists . MEASUREMENTS We administered the Addiction Severity Index and a supplemental question naire  at baseline , 4 and 12 months post- baseline . Measurements included retention in treatment , self-reported days of heroin and cocaine use , criminal behavior and arrests and urine tests for heroin and cocaine metabolites . FINDINGS At 12 months , on an intent-to-treat basis , there were no significant differences in retention in treatment among the IM , SM and RM groups ( 60.6 % , 54.8 % and 37.0 % , respectively ) . Positive urine tests for the three groups declined significantly from baseline ( Ps < 0.001 and 0.003 , for heroin and cocaine metabolites , respectively ) but there were no significant group x time interactions for these measures . At least one arrest was reported by 30.6 % of the sample during the year , but there were no significant between-group effects . CONCLUSIONS Limited availability of drug counseling services should not be a barrier to providing supervised methadone to adults dependent on heroin -- at least for the first 4 months of treatment 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 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 OBJECTIVE The objective of this secondary analysis was to explore differences in baseline clinical characteristics and  opioid replacement therapy treatment outcomes by type ( heroin , opioid analgesic [ OA ] , or combined [ heroin and OA ] ) and route ( injector or non-injector ) of opioid use . METHOD A total of 1,269 participants ( 32.2 % female ) were r and omized to receive one of two study medications ( methadone or buprenorphine/naloxone [ BUP ] )  . Of these , 731 participants completed the 24-week active medication phase . Treatment outcomes were opioid use during the final 30 days of treatment ( among treatment completers ) and treatment attrition . RESULTS Non-opioid substance dependence diagnoses and injecting differentiated heroin and combined users from OA users . Non-opioid substance dependence diagnoses and greater heroin use 
    Output:
    
AUTHORS ' CONCLUSIONS Take-home medication strategies are attractive to treatment services due to lower costs , and place less restrictions on clients , but it is unknown whether they may be associated with increased risk of diversion and unsanctioned use of medication .