Research at National Addiction Centre (NAC) at King’s College London and South London and Maudsley NHS Foundation Trust (SLaM) has played a central role in the Department of Health’s (DH) recent declaration that Injectable Opioid Treatment (IOT) is a “clinically-effective second-line treatment” for people with chronic heroin addictions who have repeatedly failed to respond to standard treatment.
The NAC led the development and introduction of the new clinical model for IOT, as well as conducting rigorous research into its clinical and cost effectiveness. As a consequence of positive findings and the publication of the Randomised Injectable Opioid Treatment Trial (RIOTT) results (Lancet, 2010), the DH has now been given approval by the UK Government to commission Phase 2 roll-out of the IOT programme.
IOT involves the prescription and supervised self-administration of injectable diamorphine (pharmaceutical heroin) or injectable methadone in a supervised clinical setting for opiate misusers who have not responded over many years to standard treatments (such as oral methadone maintenance treatment or residential rehabilitation). The primary measure of benefit in the trial was the reduction or complete quitting of use of street heroin.
Professor John Strang, Director of the National Addiction Centre says: “We are delighted that our work and that of our international colleagues has produced a quality evidence base to help this severely disadvantaged group. I would like to thank the charity Action on Addiction for their constant support during this challenging work, my colleagues at King’s and SLaM, as well as clinical colleagues at Darlington and Brighton, for their shared commitment over the past 10 years. Our collective efforts and dedication have contributed to this clinical innovation.”
With funding from the DH and the Home Office and the National Treatment Agency for Substance Misuse, and support from the charity Action on Addiction (and, through them, the Community Fund and Hedley Foundation), Professor Strang and colleagues at the NAC worked to refine previous IOT trials from Switzerland, the Netherlands and Germany. Led by the NAC, RIOTT is the result of a ten year collaboration between the Institute of Psychiatry at King’s and SLaM. Research took place over three clinics in the UK (South London, Darlington and Brighton) and in 2010, the primary outcome results were published in the Lancet.
Currently, researchers at the NAC are undertaking health economic analyses to establish the cost effectiveness of IOT as well as analyses of treatment response prediction and longer-term follow-up.
The results of the RIOTT study, along with other international research, form the evidence base for the current roll-out of IOT in the UK. The DH is now inviting potential service providers to host supervised injecting clinics.
To watch Prof Strang discuss the RIOTT trial, please click here
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