Patterns of acquisitive crime during methadone maintenance treatment among patients eligible for heroin assisted treatment.

OBJECTIVE: To determine the patterns of acquisitive crime during methadone maintenance treatment among chronic, treatment-resistant heroin users eligible for heroin assisted treatment in the Netherlands. METHODS: We retrospectively assessed the type and number of illegal activities during 1 month of standard methadone maintenance treatment in 51 patients prior to the start of heroin assisted treatment. Data were collected using a semi-structured interview focussed on crime with special emphasis on property crime. Volume analyses consisted of frequencies and descriptives of mean numbers of offences per day and per type. RESULTS: In a Dutch population of problematic drug users eligible for and prior to commencing heroin assisted treatment, 70% reported criminal activities and 50% reported acquisitive crimes. Offending took place on 20.5 days per month with on average 3.1 offences a day. Acquisitive crime consisted mainly of shoplifting (mean 12.8 days, 2.2 times/day) and theft of bicycles (mean 5.8 days, 2.4 times/day); theft from a vehicle and burglaries were committed less frequently. The majority of these patients (63%) reported to have started offending in order to acquire illicit drugs and alcohol. CONCLUSION: During methadone maintenance treatment, 50% of criminally active, problematic heroin users eligible for heroin assisted treatment reported acquisitive crime. Shoplifting, thefts and/or other property crimes were committed on average two to three times on a crime day. This study discusses that the detail provided by self-reported crime data can improve cost estimates in economic evaluations of heroin assisted treatment.

Validity of the EQ-5D as a generic health outcome instrument in a heroin-dependent population.

OBJECTIVE: To evaluate the validity of the EuroQol (EQ-5D) in a population of chronic, treatment-resistant heroin-dependent patients. METHODS: The EQ-5D is studied relative to the Maudsley Addiction Profile (MAP), the Symptom Checklist (SCL-90) and the European Addiction Severity Index (EuropASI) which were used to assess the participant's physical functioning, mental health and social integration, respectively. Data were gathered from 430 patients participating in the Dutch heroin trials with an intended 12-month treatment period. The EQ-5D was used as a separate health outcome measure. Statistical analyses were conducted using Spearman's and Pearson's correlations. RESULTS: The EQ-5D dimensions mobility, self-care and usual activities generally showed low correlations with relevant parameters of the MAP-HSS, SCL-90 and EuropASI (r=0.132-0.369). The EQ-5D dimension pain/discomfort showed low to moderate hypothesized correlations with all disease-specific measures (r=0.153-0.496). The EQ-5D dimension anxiety/depression showed moderate to high correlations with the SCL-90 (including the sum score) and some of the EuropASI parameters (r=0.133-0.615). The EQ-5D utility scores were moderately correlated with the MAP-HSS (r=-0.468) and the SCL-90 (r=-0.491) total score and with response to treatment at month 12. CONCLUSION: The majority of hypothesized associations between the EQ-5D and the disease or domain-specific measures could be confirmed. The validity of the EQ-5D-based utility score appears to be suitable in the evaluation of chronic, heroin-dependent populations.

Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials.

OBJECTIVE: To determine the cost utility of medical co-prescription of heroin compared with methadone maintenance treatment for chronic, treatment resistant heroin addicts. DESIGN: Cost utility analysis of two pooled open label randomised controlled trials. SETTING: Methadone maintenance programmes in six cities in the Netherlands. PARTICIPANTS: 430 heroin addicts. INTERVENTIONS: Inhalable or injectable heroin prescribed over 12 months. Methadone (maximum 150 mg a day) plus heroin (maximum 1000 mg a day) compared with methadone alone (maximum 150 mg a day). Psychosocial treatment was offered throughout. MAIN OUTCOME MEASURES: One year costs estimated from a societal perspective. Quality adjusted life years (QALYs) based on responses to the EuroQol EQ-5D at baseline and during the treatment period. RESULTS: Co-prescription of heroin was associated with 0.058 more QALYs per patient per year (95% confidence interval 0.016 to 0.099) and a mean saving of 12,793 euros (8793 pounds sterling, 16,122 dollars) (1083 to 25,229 euros) per patient per year. The higher programme costs (16 222 euros; lower 95% confidence limit 15,084 euros) were compensated for by lower costs of law enforcement (- 4129 euros; upper 95% confidence limit - 486 euros) and damage to victims of crime (- 25,374 euros; upper 95% confidence limit - 16,625 euros). The results were robust for the use of national EQ-5D tariffs and for the exclusion of the initial implementation costs of heroin treatment. Completion of treatment is essential; having participated in any abstinence treatment in the past is not. CONCLUSIONS: Co-prescription of heroin is cost effective compared with treatment with methadone alone for chronic, treatment resistant heroin addicts.