Abstract
Psychiatric disorders occur frequently in individuals with opiate dependence in epidemiology and in clinical studies. A relief from emotional distress is considered to contribute to these elevated rates. Such an effect may contribute to the attractiveness of opioid maintenance treatment for dual diagnosis patients.
Psychiatric disorders risk to be overlooked in addiction treatment resulting in frequent dropouts. In opioid maintenance treatment, including methadone maintenance, lack of mental health care may lead to continued use of street heroin and other non-prescribed substances. Heroin maintenance was designed and tested in the 1990s as a response to such failures.
In contrast to the traditional practice in the UK of handing out heroin prescriptions to addicts, the new maintenance concept includes a comprehensive assessment and care programme. It is reserved for otherwise treatment-refractory patients. Rates of psychiatric comorbidity are high at entry to heroin maintenance. The potential to provide a safe and efficient answer to such treatment-refractory patients was researched in six countries. The good retention, reductions in illicit drug use and crime, and improvements in somatic and mental health were confirmed repeatedly. New heroin maintenance became part of the routine treatment system in five countries.
In three out of six randomised controlled trials, comparing heroin and methadone maintenance, heroin maintenance resulted in a significantly better outcome for comorbid patients.
In conclusion, maintenance treatment for opiate addicts must be prepared to take care of dual diagnosis patients; for treatment-refractory patients the new heroin maintenance treatment is a valuable rescue option.
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Uchtenhagen, A.A. (2015). Psychiatric Comorbidity in Heroin Maintenance and Methadone Maintenance Treatments. In: Dom, G., Moggi, F. (eds) Co-occurring Addictive and Psychiatric Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-45375-5_24
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