Patients in heroin maintenance programs used less illicit heroin than those on methadone | Research

The takeaway

Urine testing showed 50% illicit heroin co-use in heroin maintenance patients versus 71% in methadone patients, while cannabis use remained high in both groups during treatment.

Read this if you are interested in substance co-use patterns during opioid addiction treatment.

50% illicit heroin co-use in HMP vs 71% in MMP

What the researchers found

Researchers analyzed urine samples from patients in a heroin maintenance program (HMP) and a methadone maintenance program (MMP) at one month before and 6 and 12 months into treatment.

Illicit heroin co-use was detected in 50% of HMP patients, significantly lower than the 71% rate in MMP patients. This higher detection rate compared to previous reports resulted from testing for multiple markers of illicit heroin beyond just acetylcodeine.

Cocaine use was similar between groups and decreased during treatment. Benzodiazepine use also decreased over time. Cannabis use remained high in both groups throughout treatment. Amphetamine use was minimal in both programs.

Why it matters

The finding that cannabis use remained persistently high during opioid addiction treatment raised questions about whether cannabis serves a functional role for patients in these programs.

The numbers in context

Illicit heroin co-use: 50% in HMP vs 71% in MMP (significant difference). Cocaine and benzodiazepine use decreased during treatment in both groups. Cannabis use remained high in both groups.

How the study worked

Observational comparison study analyzing urine samples chromatographically for heroin markers and immunochemically for cannabinoids, cocaine metabolites, amphetamines, MDMA-type substances, and benzodiazepines. Samples collected at 1 month pre-treatment, 6 months, and 12 months.

What this study cannot tell us

Observational comparison between programs without randomization. Differences between programs may reflect patient selection rather than treatment effects. Single center study.

How to read the evidence

Observational comparison study with objective urine testing but without randomization between programs.

When this study was published

Published in 2010. Harm reduction approaches to opioid addiction have evolved significantly since.

The bigger picture

This study contributed to harm reduction research by comparing supervised heroin programs to methadone maintenance, while also documenting persistent cannabis use as a common feature of both treatment approaches.

Questions still open

Why did cannabis use remain high during opioid treatment? Does concurrent cannabis use help or hinder opioid addiction recovery?

Common questions

What is a heroin maintenance program?

A supervised program where patients receive pharmaceutical-grade heroin under medical supervision as an alternative to methadone, aimed at reducing illicit drug use and associated harms.

Why was cannabis use so persistent during treatment?

The study documented high cannabis use in both programs but did not investigate reasons. Cannabis may serve different functions for patients in opioid treatment that warrant separate study.

Read the original research

Comparison of urine results concerning co-consumption of illicit heroin and other drugs in heroin and methadone maintenance programs.

International journal of legal medicine, 124(5), 499-503

View on PubMed ↗Publisher’s paper ↗

Citation

Musshoff, Frank; Trafkowski, Jens; Lichtermann, Dirk; Madea, Burkhard. (2010). Comparison of urine results concerning co-consumption of illicit heroin and other drugs in heroin and methadone maintenance programs.. International journal of legal medicine, 124(5), 499-503. https://doi.org/10.1007/s00414-009-0361-8