***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 BACKGROUND Despite evidence of the effectiveness of injectable opioid treatment compared with oral methadone for chronic heroin addiction , the additional cost of injectable treatment is considerable , and cost-effectiveness uncertain . AIMS To compare the cost-effectiveness of  supervised injectable heroin and injectable methadone with optimised oral methadone for chronic refractory heroin addiction . METHOD Multisite , open-label , r and omised controlled trial . Outcomes were assessed in terms of quality -adjusted life-years ( QALYs ) . Economic perspective included health , social services and criminal justice re sources . RESULTS Intervention costs over 26 weeks were significantly higher for injectable heroin ( mean £ 8995 v. £ 4674 injectable methadone and £ 2596 oral methadone ; P<0.0001 ) . Costs overall were highest for oral methadone ( mean £ 15 805 v. £ 13 410 injectable methadone and £ 10 945 injectable heroin ; P = n.s . ) due to higher costs of criminal activity . In cost-effectiveness analysis , oral methadone was dominated by injectable heroin and injectable methadone ( more expensive and less effective ) . At willingness to pay of £ 30 000 per QALY , there is a higher probability of injectable methadone being more cost-effective ( 80 % ) than injectable heroin . CONCLUSIONS Injectable opioid treatments are more cost-effective than optimised oral methadone for chronic refractory heroin addiction . The choice between supervised injectable heroin and injectable methadone is less clear . There is currently evidence to suggest superior effectiveness of injectable heroin but at a cost that policy makers may find unacceptable . Future research should consider the use of decision analytic techniques to model expected costs and benefits of the treatments over the longer term Prescribing of injectable diacetylmorphine ( DAM ) for heroin dependence has raised concerns about its safety . In light of various reports by heroin-maintained patients of DAM-related adverse events , and previously established unwanted effects of opioids in pain management , we undertook a survey in February 2001 of a r and om sample of 132 ( 127 participated ) of 1061 patients prescribed DAM in Switzerl and at that time . The purpose was to document the prevalence rates of a list of unintended symptoms experienced and attributed to DAM by patients . To assess symptom complaints and other data , staff administered a six-page self-report question naire . The patients ascribed numerous symptoms to DAM , with the best-known being the most frequently reported ( e.g. skin itching , sweating , constipation ) . Among potentially more problematic complaints ranged irregular menses , cognitive deficits , muscle twitches , labored breathing , pains in the cardiac region , and temporary paralysis of limbs . In the absence of a control group , however , these may also be due to other factors , such as expectation , co-medication , concomitant substance use or co-morbidity . This pilot study emphasizes the necessity of rigorous assessment of the true rates , types , severity and preventability of such complications , especially given the current efforts to establish heroin maintenance as an optional treatment for heroin dependence 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 BACKGROUND Switzerl and introduced a pragmatic national drug policy when the former conservative abstinence-orientated politics proved unable to cope with an escalating number of users and related negative consequences for public health and public order . The high visibility of ' needle parks ' and the size of the acquired immune deficiency disorder ( AIDS ) epidemic called for a new approach and for national leadership . AIMS To describe the intentions , the process and the results of setting up the new treatment approach of prescribing heroin to treatment resistant heroin addicts , as an example of drug policy change . MATERIAL S AND METHODS A systematic collection of relevant documents is analysed and used as evidence for describing the process of policy change . RESULTS Measures to reduce the negative consequences of continued use and to prevent the spread of AIDS were started mainly by private initiatives and soon taken up officially in the ' four-pillar ' drug policy ( including harm reduction , prevention , treatment and law enforcement ) . Medical prescription of heroin to chronic , treatment-resistant heroin addicts was one of the innovations , based on extensive scientific and political preparation . Detailed documentation and evaluation , ample communication of results , adaptations made on the basis of results and extensive public debate helped to consoli date the new policy and heroin-assisted treatment , in spite of its limitations as an observational cohort study . All necessary steps were taken to proceed from a scientific experiment to a routine procedure . DISCUSSION Comparable policy changes have been observed in a few other countries , such as The Netherl and s and Germany , based on the Swiss experience , with equally positive results of heroin-assisted treatment . These experiments were design ed as r and omised controlled trials , comparing intravenous heroin against oral methadone , thereby demonstrating the specific value of pharmaceutical diamorphine for maintenance treatment in opiate dependence . The positive impact of policy change and the positive outcomes of heroin-assisted treatment were acknowledged increasingly nationally and internationally , but made it difficult to continue the process of adapting policy to new challenges , due to the low visibility of present drug problems and to changing political priorities . CONCLUSION A major change in drug policy was effectively realised under typical conditions of a federalist country with a longst and ing tradition of democratic consensus building . Facilitating factors were the size and visibility of the heroin problem , the rise of the Aids epidemic , and a pragmatic attitude of tolerating private initiatives opening the way to official policy change 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 AIMS To describe 4-year treatment retention and treatment response among chronic , treatment-resistant heroin-dependent patients offered long-term heroin-assisted treatment ( HAT ) in the Netherl and s. DESIGN Observational cohort study . SETTING AND INTERVENTION Out-patient treatment in specialized heroin treatment centres in six cities in the Netherl and s , with methadone plus injectable or inhalable heroin offered 7 days per week , three times per day . Prescription of methadone plus heroin was supplemented with individually tailored psychosocial and medical support . PARTICIPANTS Heroin-dependent patients who had responded positively to HAT in two r and omized controlled trials and were eligible for long-term heroin-assisted treatment ( n = 149 ) . MEASUREMENTS Primary outcome measures were treatment retention after 4 years and treatment response on a dichotomous , multi-domain response index , comprising physical , mental and social health and illicit substance use . FINDINGS Four-year retention was 55.7 % [ 95 % confidence interval ( CI ) : 47.6 - 63.8 % ] . TREATMENT Response was significantly better for patients continuing 4 years of HAT compared to patients who discontinued treatment : 90.4 % versus 21.2 % [ difference 69.2 % ; odds ratio ( OR ) = 48.4 , 95 % CI : 17.6 - 159.1 ] . Continued HAT treatment was also associated with an increasing proportion of patients without health problems and who had stopped illicit drug and excessive alco 
    Output:
    
SIH is found to be an effective way of treating heroin dependence refractory to st and ard treatment .
SIH may be less safe than MMT and therefore requires more clinical attention to manage greater safety issues .
Inclusion of this low-volume , high-intensity treatment can now improve the impact of comprehensive healthcare provision