Le traitement assisté par héroïne a montré plus d'efficacité que le traitement par méthadone
Bibliographic record
Abstract
Background: A fraction of patients receiving methadone treatment pursues their use of street heroin. In Switzerland, a new treatment with prescribed diacetylmorphine (pharmaceutical heroin) was developed to help these heroin addicts resistant to methadone treatment to decrease their street heroin use. In this heroin-assisted treatment (HAT), diacetylmorphine is prescribed to severe heroin user and diacetylmorphine is administered by patients under the supervision of nurses in a specific centre. Six randomised controlled trials compared HAT to methadone treatment: in Switzerland, The Netherlands, Spain, Germany, Canada and United- Kingdom. HAT showed better efficacy than methadone. Patients used less street heroin, their health improved and their criminal behaviour decreased. A new trial assessed in Belgium the feasibility and efficacy of this treatment compared to methadone treatment. Methods: The TADAM (Treatment Assisted by Diacetylmorphine) was an open label randomised controlled trial developed on the Swiss model of HAT developed in 1994. Main inclusion criteria were 5 years of heroin addiction, (almost) daily use of street heroin and a previous attempt of methadone treatment. As in the Dutch experiment, patients could choose to inhale or to inject diacetylmorphine in the new HAT centre. HAT was stopped after 12 months and the best available treatment was offered to the patient. The research team assessed subjects every three months with standardised questionnaires (EuropASI, MAP-HSS, SCL-90-R) and questions on involvement in a criminal milieu. We completed our reported data with toxicological analysis and criminal proceedings. Results: 74 subjects were randomised in the trial: 36 in the experimental group and 38 in the control group. According to the primary efficacy criterion, the experimental group counted at least 30% more responders than the control group after 3 months (p<0.05), 6 months (p<0.05) and 9 months (p<0.01). At the 12 month assessment, the number of responders was still higher in the experimental group but the difference (11%) was no more significant (p=0.35). At the 12 month assessment, the condition of patients in the experimental group worsened compared to the 9 month assessment. This effect was not seen in the control group were patients could continue their methadone treatment after the 12 months. Conclusion: As in other countries, HAT is an effective treatment for severe heroin addicts resistant to methadone treatment. However, a predetermined duration of 12 month counteracts the efficacy of this treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".