***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 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 AIMS To evaluate the effectiveness of buprenorphine compared with methadone maintenance therapy in opiate addicts over a treatment period of 24 weeks . DESIGN Subjects were r and omized to receive either buprenorphine or methadone in an open , comparative study . SETTING Subjects were recruited and treated at the drug addiction outpatient clinic at the University of Vienna . PARTICIPANTS Sixty subjects ( 19 females and 41 males ) who met DSM-IV criteria for opioid dependence and were seeking treatment . INTERVENTION Subjects received either sublingual buprenorphine ( 2-mg or 8-mg tablets ; maximum daily dose 8 mg ) or oral methadone ( racemic D -/+ L-methadone ; maximum daily dose 80 mg ) . A stable dose was maintained following the 6-day induction phase . MEASUREMENT Assessment of treatment retention and illicit substance use ( opiates , cocaine and benzodiazepines ) was made by urinalysis . FINDINGS The retention rate was significantly better in the methadone maintained group ( p < 0.05 ) but subjects completing the study in the buprenorphine group had significantly lower rates of illicit opiate consumption ( p = 0.04 ) . CONCLUSION The results support the superiority of methadone with respect to retention rate . However , they also confirm previous reports of buprenorphine use as an alternative in maintenance therapy for opiate addiction , suggesting that a specific subgroup may be benefiting from buprenorphine . This is the first comparative trial to use sublingual buprenorphine tablets : previously published comparison studies refer to 30 % solutions of buprenorphine in alcohol This study compared the efficacy of buprenorphine to methadone for decreasing cocaine use in patients with combined opioid and cocaine use . Participants ( n=51 ) were enrolled in a 26-week treatment program and r and omly assigned to either buprenorphine or methadone . Dosing was double-blind and double-dummy . Patients were stabilized on either 8 mg sublingual buprenorphine or 50 mg oral methadone , with dose increases given in response to continued illicit cocaine use or opioid use through week 16 of treatment . Maximum doses possible were 16 mg buprenorphine and 90 mg methadone . Average doses achieved were 11.2 mg buprenorphine and 66.6 mg methadone ; 49 % of the patients received the maximum doses possible . Urine sample s were collected three times per week , and there was no significant difference in the rate of cocaine positive urines for the intent-to-treat sample ( 69 % for buprenorphine versus 63 % for methadone ) . For patients who remained in treatment through the flexible dosing period ( n=28 ) , there were significant decreases in cocaine positive urines over time ( P<0.01 ) , but no significant differences between groups or group × time effects . Buprenorphine and methadone were equally effective on measures of treatment retention , urine results for opioids , and compliance with attendance and counseling . These results demonstrate no selective efficacy of either buprenorphine or methadone in attenuating cocaine use in this population , but do provide further support for the equivalent efficacy of buprenorphine and methadone in the treatment of opioid dependence It is estimated that more than 500 000 people in the United States are dependent on opioids [ 1 , 2 ] . Methadone , a synthetic opioid first reported as a treatment agent for opioid dependence by Dole and Nysw and er in 1965 [ 3 ] , is the most widely used pharmacologic treatment for opioid dependence . The National Drug and Alcoholism Treatment Unit Survey ( NDATUS ) determined a point prevalence of 92 715 opioid abusers treated in 758 methadone treatment programs on 30 September 1989 [ 4 ] . When used in conjunction with counseling services , methadone treatment has been associated with reduced rates of criminal activity , illicit drug use , and needle sharing and with improved rates of employment [ 5 - 9 ] . With the recognition of intravenous drug use as a primary risk factor for infection with human immunodeficiency virus ( HIV ) , improved access to methadone treatment has been identified as an important means for reducing the risk of HIV infection [ 10 , 11 ] . Although methadone treatment is effective in decreasing opioid use , recent studies have reported considerable variability across clinics in rates of continued intravenous drug use during treatment [ 12 ] . One aspect of this problem is that intravenous use of cocaine has become a serious problem among  methadone treatment patients [ 13 - 16 ] . Few systematic studies have addressed the efficacy of  methadone treatment since the onset of the cocaine epidemic [ 17 ] . Such research could re-evaluate in a contemporary population sample methadone 's specific pharmacologic efficacy in decreasing opioid use [ 18 - 20 ] while providing new information about any potential effect of methadone treatment on concurrent cocaine use . The issue of appropriate methadone dosing levels is highly pertinent because low-dose treatment has been strongly associated with poor drug use outcomes in descriptive clinical studies [ 12 , 21 ] and because a substantial number of clinics continue to use low doses of methadone [ 22 ] . For example , a report prepared by the General Accounting Office ( GAO ) that summarized the dosing practice s of 24 methadone programs in eight states found that doses ranged widely ( from 21 to 68 mg ) and 29 % had a mean dose of less than 40 mg [ 23 ] . Thus , despite more than 25 years of clinical experience , optimal dosing levels of methadone remain controversial [ 24 , 25 ] . Previous studies of methadone dosing have either surveyed clinics for their dosing practice and related doses to clinic-wide outcomes or have r and omly assigned patients to a specific predetermined dose of methadone using clinical trial methods . Naturalistic survey studies [ 5 , 6 , 12 , 21 , 26 ] , although valuable for identifying associations between dose and outcome , are method ologically compromised by confounding factors that differ across the clinics surveyed . Previous early clinical trials of methadone dosing [ 27 - 29 ] are also method ologically compromised ( for example , being single-blinded ) or only tested higher doses of methadone [ 30 ] . Thus there is a need for well-controlled research on methadone dosing reflecting doses in common use and incorporating the changing patient population . In this controlled clinical trial we compared moderate and low methadone dosing to methadone-free treatment , providing data in a contemporary population sample of opioid addicts and examining the effect of methadone dose on cocaine as well as opioid use . Methods Participants were 247 persons who had consecutive admissions to a methadone research clinic from September 1988 through July 1990 . The mean age was 34 years , 70 % were male , and 50 % were black . Most were unmarried ( 84 % ) and unemployed ( 62 % ) . They had an average of 11 years of education , were generally legally free ( 72 % ) , and had a mean of two previous admissions for drug abuse treatment . Their primary drug of choice was intravenous heroin , and 47 % reported using cocaine in the 30 days before their application to treatment . Eligibility criteria for study participation were age between 18 and 50 years , history of intravenous opioid dependence ( including documentation of previous treatment for opioid dependence or legal involvement secondary to opioid use , a urine sample positive for opioids , and physical examination consistent with acute and chronic needle use ) , no chronic medical illnesses , absence of a major mental illness , a negative pregnancy test for women , and at least 3 months since the patient 's last treatment at the clinic . Applicants who failed to fulfill the study 's eligibility criteria were assisted in seeking an alternate treatment program . The study was approved by the institutional review board , and informed consent was obtained from each patient at the time of admission to the study . Study Procedures Applicants who fulfilled the eligibility criteria were admitted to a 6-month short-term methadone treatment program .  Participants were stratified as to race and sex and were assigned to one of three fixed-dose methadone schedules ( Figure 1 ) . Treatment group assignment , stabilization doses , and dosing schedules were double-blind for all patients and the clinic staff who had patient contact . All patients received a minimum of 35 days of active methadone during the first 5 weeks of treatment ; this was followed by a 15-week stabilization period at either 50 , 20 , or 0 mg of methadone . Thus , patients assigned to the 0-mg treatment group received 35-day methadone detoxification . During weeks 21 through 26 , the methadone dose was gradually tapered for those patients still receiving active medication because this was a short-term ( 182-day ) treatment episode . A sub sample of patients ( n = 44 ) assigned to the 0-mg treatment group received a more prolonged ( 8-week ) induction period , reaching 0 mg at the start of week 9 to compare the effects of a faster to a slower detoxification protocol . In this report data for patients in the alternate 0-mg treatment groups are collapsed . Figure 1 . Dosing schedule . Treatment Procedures Patients were assigned an individual counselor who set treatment goals and developed an individualized treatment plan . Patients were given weekly group therapy focusing on relapse prevention . On-site medical services were provided by a full-time internist and a part-time nurse practitioner . Take-home medication was provided only on legal holidays and for documented extenuating circumstances ( for example , funeral out of town for a death in the family ) . Patients who failed to attend the clinic for 3 consecutive days were discharged from treatment . Outcome Measures Tre 
    Output:
    
FINDINGS Retention in treatment : MMT is more effective than MDT , no treatment , BMT , LMT , and heroin plus methadone .
MMT proved to be less effective than injected heroin alone .
High doses of methadone are more effective than medium and low doses .
Use of heroin : MMT is more effective than waiting list , less effective than LAAM , and not different from injected heroin .
No significant results were available for mortality and criminal activity .
CONCLUSIONS These findings confirm that MMT at appropriate doses is the most effective in retaining patients in treatment and suppressing heroin use but show weak evidence of effectiveness toward other relevant outcomes .