Reductions in acquisitive crime and drug use after treatment of addiction problems: 1-year follow-up outcomes

The relationship between acquisitive crime and drug misuse problems was studied among 753 clients recruited to the National Treatment Outcome Research Study (NTORS). More than 17000 offences were reported during the 90-day period prior to treatment. Half of the clients committed no acquisitive crimes during this period whereas 10% committed 76% of the crimes. At 1-year follow-up, the number of crimes was reduced to one third of intake levels, and criminal involvement was reduced by about half. Reductions in regular heroin use were strongly associated with reductions in crime. The reduction in crime following treatment is of great importance and provides immediate benefit to society through the reduced economic costs of crime.     

Criminal convictions among dependent heroin users during a 3-year period prior to opioid maintenance treatment: a longitudinal national cohort study

This study investigates frequency and types of criminal convictions among a national sample of heroin users during a 3-year period prior to opioid maintenance treatment (OMT). All heroin users (N = 3,789) in Norway who applied for and were eligible for OMT (1997–2003) were included. The OMT records were cross-linked to Norwegian crime statistics. During observation, 24,478 convictions were recorded among 60.9% of the sample. Differences of criminal convictions were found within the group; a large proportion (39.1%) had no convictions, whereas 10% of the sample was responsible for 37.8% of all convictions. Convictions for acquisitive crimes and drug crimes were the most common. Variations in the cohort's individual crime sequences were found. The heavy involvement of heroin users with the criminal justice system provides an opportunity to intervene with dependent offenders. Coordination between treatment providers and police or courts can play an important role in improving outcomes through better access to treatment.     

Drug selling among drug misusers before intake to treatment and at 1-year follow-up: results from the National Treatment Outcome Research Study (NTORS)

Drug misusers recruited to the National Treatment Outcome Research Study were interviewed at intake to treatment programmes throughout England ( n = 1075), and after 1 year ( n = 753). Data were collected on self-reported involvement in and frequency of drug-selling activities and other crimes during the 90-day periods prior to each interview. A huge number of drug-selling offences (39 153) was reported prior to intake. Fewer than one-third of the clients (29%) reported selling drugs during the 90 days prior to intake, and among those clients who had sold drugs, drug selling was an infrequent and occasional activity. Most clients reported not selling drugs. A small minority (7%) committed the majority (89%) of drug-selling offences. These high-rate drug sellers reported different patterns of substance misuse to other drug sellers, including more frequent use of heroin but less severe dependence upon heroin, and less frequent drinking. The involvement of these highrate drug sellers may reflect a more 'professional' approach to dealing. Reductions in dealing were found for clients from both residential and methadone programmes. Overall, the number of dealing offences at 1 year was reduced to a less than one-fifth of intake levels and the rate of involvement in crime was also reduced to less than two-thirds of intake levels. Reductions in drug selling were associated with reductions in regular heroin use. \[Gossop M, Marsden J, Stewart D. Drug selling among drug misusers before intake to treatment and at 1-year follow-up: results from the National Treatment Outcome Research Study (NTORS). Drug Alcohol Rev 2000;19:143-151]     

Incarcerated intravenous heroin users: Predictors of post-release utilization of methadone maintenance treatment

Incarcerated intravenous heroin users have more problematic patterns of heroin use, but are less likely to access methadone maintenance treatment by their own initiative than heroin users in the community. The present study examined predictors for receiving methadone maintenance treatment post-release among incarcerated intravenous heroin users within a 24-month period. This cohort study recruited 315 incarcerated intravenous heroin users detained in 4 prisons in southern Taiwan and followed up within the 24-month period post-release. Cox proportional hazards regression analysis was applied to determine the predictive effects of sociodemographic and drug-use characteristics, attitude toward methadone maintenance treatment, human immunodeficiency virus serostatus, perceived family support, and depression for access to methadone maintenance treatment after release. There were 295 (93.7%) incarcerated intravenous heroin users released that entered the follow-up phase of the study. During the 24-month follow-up period, 50.8% of them received methadone maintenance treatment. After controlling for the effects of the detainment period before and after recruitment by Cox proportional hazards regression analysis, incarcerated intravenous heroin users who had positive human immunodeficiency virus serostatus (HR = 2.85, 95% CI = 1.80–4.52, p < .001) and had ever received methadone maintenance treatment before committal (HR = 1.94, 95% CI = 1.23–3.05, p < .01) were more likely to enter methadone maintenance treatment within the 24-month follow-up period. Positive human immunodeficiency virus serostatus with fully subsidized treatment and previous methadone maintenance treatment experiences predicted access of methadone maintenance treatment post-release. Strategies for getting familiar with methadone maintenance treatment during detainment, including providing methadone maintenance treatment prior to release and lowering the economic burden of receiving treatment, may facilitate entry of methadone maintenance treatment for incarcerated intravenous heroin users.     

Ongoing cocaine and benzodiazepine use: Effects on acquisitive crime committal rates amongst opiate users in treatment

Aims: Research has shown that treatment for opiate use reduces crime, however the extent to which this is maintained is open to question. The objective of this study was to measure the relationship between crime committal rates and ongoing benzodiazepine and cocaine use by clients in opiate drug treatment programs.

Methods: A national, prospective, longitudinal, multi-site drug treatment outcome study was conducted, 404 participants were recruited from inpatient and outpatient settings and 97% were located at 3 years. Drug use and crimes committed were ascertained from the Maudsley Addiction Profile of Marsden et al. [Marsden, J., Gossop, M., Stewart, D., Best, D., Farrell, M., Lehmann, P.,?…?Strang, J. (1998). The Maudsley Addiction Profile (MAP): A brief instrument for assessing treatment outcome. Addiction, 93, 1857–1867].

Findings: Analysis revealed that of those who had not committed an acquisitive crime at intake, those who used cocaine regularly at 1-year were 6.5 times more likely and those that used benzodiazepines regularly were eight times more likely to commit an acquisitive crime at 1-year. Of those who had committed an acquisitive crime at intake, those who used heroin regularly at 1-year were nine times more likely to commit acquisitive crime at 1-year than those who did not use heroin regularly at 1 year.

Conclusions: Treatment must place greater emphasis on reducing substitute drug use if opiate treatment is to effectively sustain crime reduction.     

Decrease in self-reported offences and incarceration rates during methadone treatment: A comparison between patients switching from buprenorphine to methadone and maintenance treatment incident users (ANRS-Methaville trial)

BackgroundPatients receiving buprenorphine who are poor responders can continue to commit drug-related offences. Switching them from buprenorphine to methadone may result in reduced criminal behaviour. We compared self-reported offences and incarceration before and after starting methadone treatment of patients switching from buprenorphine (PSB) and maintenance treatment incident users (MIU).MethodsData on offences, incarceration and other information, were obtained via a telephone interview. Mixed models were used to assess the impact of methadone initiation and being PSB or MIU on (1) the number of days when offences were committed (drug sale, drug purchase, other offences) and (2) experiencing incarceration during the previous 6 months.ResultsAmong the 176 patients with at least one assessment for self-reported offences, 51.7% were PSB. Receiving methadone was significantly associated with a reduction in the number of days when drug sale or drug purchase offences were committed, but not other offences. PSB and MIU groups were different only for drug purchase, as PSB were more likely to have a higher number of days of drug purchase from month 3 onwards. A reduction of 77% in the likelihood of experiencing incarceration was observed and this was comparable in PSB and MIU.ConclusionSwitching non-responding buprenorphine patients to methadone can result in a major reduction in offences and incarceration rates. Increasing access to methadone, using more flexible models of care is urgent for clinical and public health reasons.     

The day-to-day criminality of heroin addicts in Baltimore--a study in the continuity of offence rates

A representative sample of 354 male heroin addicts living in the Baltimore metropolitan area was traced from onset of opiate use to time of interview to ascertain any changes in the frequency or type of offences committed during their years at risk. Five basic measures of criminality were employed: crime-day theft, crime-day violence, crime-day dealing, crime-day con games and crime-day other offences. A sixth measure -- composite crime day -- incorporated all five crime-day measures. Crime rates per year were derived from these six measures. It was found that the start of addiction was associated with a high level of criminality (255 composite crime-days per year), and that this high rate continued over numerous subsequent periods of addiction. Theft of property was the most common type of crime, followed by drug sales, other offences, con games, and violent offences. In contrast to the addiction periods, criminality decreased over successive non-addiction periods. Thus, the composite crime rate (82 composite crime-days per year) for the first non-addiction period was only 32% of the rate of the first addiction period and this lower rate of criminality decreased markedly thereafter.     

Changes in Licensing Law in England and Wales and Alcohol-Related Mortality

The study investigates developmental associations in the relationship between drug use and crime among 100 treatment-seeking opiate addicts. While 56% of the sample report having committed 2,785 acquisitive crimes in the previous month, there are strong developmental patterns. Those who have committed crimes before age 14 have earlier onset of tobacco, alcohol, cannabis and cocaine use and a lower first age of heroin problems. This relates to perceptions - those who believe drug use caused crime before the age of 14 have lower age of onset for tobacco and cocaine use and for heroin problems. The developmental patterns suggest strong associations between drug use and crime, but provide no support for a casual model in which drug use leads to crime.     

Patterns of opiate use in a heroin maintenance programme

RATIONALE: Little is known about patterns of opiate use by heroin addicts. OBJECTIVES: To describe opiate use over time among heroin addicts who had access to legally prescribed intravenous heroin and oral opiates. METHODS: Analysis of daily drug administration records of 37 patients enrolled in the Geneva heroin maintenance programme for 4-29 months (total 23,136 patient-days). RESULTS: The average dose of intravenous heroin was 466 mg/day; the total opiate dose, after conversion of oral opiates to heroin-equivalents, was 543 mg/day. Patients received intravenous heroin only on 39% of days, oral opiates only on 7% of days, and mixed regimens on 49% of days; the remaining 4% of days were spent outside the programme, usually on oral opiates. The daily dose of heroin-equivalents increased during the first trimester in the programme, by 30 mg/day per month (95% confidence interval 12-46 mg/day per month), but decreased gradually thereafter, by 12 mg/day per month (95% confidence interval, 8-17 mg/day per month). In patients who alternated between heroin and methadone, 1 mg methadone typically replaced 4.1 mg heroin. During follow-up, five patients switched to methadone maintenance, five underwent detoxification, and three were discharged for noncompliance with regulations. CONCLUSIONS: Heroin users who have facilitated access to legally prescribed drugs consume about 0.5 g heroin per day. Consumption patterns vary, but the daily amount of opiates remains stable or decreases over time. A substantial minority of patients elect for alternative treatments after several months of heroin maintenance.     

Low-threshold methadone treatment, heroin price, police activity and incidence of heroin use: The Zurich experience

BackgroundThere still are concerns about unwanted effects of harm-reduction measures that may lead to an increasing number of new heroin users. Furthermore, it is thought that the admission of a substantial proportion of heroin users to methadone treatments reduces the demand on the heroin market and thus results in a lower price for street heroin. And finally, the intensity of police activity in the drug field may also affect prices for street heroin.MethodsAs incidence of regular heroin use over more than a decade is rarely known elsewhere, we examined the Zurich experience between 1980 and 2005 by triangulating published and unpublished data, concerning heroin price, heroin purity level, heroin seizures and drug offences. This time period encompasses the time before and after the introduction of low-threshold methadone treatment in 1991.ResultsWe found a steep peak of heroin incidence in 1990. The street price of heroin already declined from 700 to 60 Swiss Francs during the 80s. The number of heroin consumptions possession offences reported by the police increased since 1991 and peaked in 1997, 2 years after the closure of the last open drug scene.ConclusionThe introduction of low-threshold methadone treatment has not resulted in lower heroin prices and the increased police activity during the 90s has not led to higher heroin prices, even though the higher police activity in the late 90s may have contributed to the prevention of a re-establishment of open drug scenes. In conclusion, we did not find a close relationship between street prices of heroin, police activity, and incidence of problematic heroin use.     

Value for money in drug treatment: economic evaluation of prison methadone

BACKGROUND: Although methadone maintenance treatment in community settings is known to reduce heroin use, HIV infection and mortality among injecting drug users (IDU), little is known about prison methadone programs. One reason for this is the complexity of undertaking evaluations in the prison setting. This paper estimates the cost-effectiveness of the New South Wales (NSW) prison methadone program. METHODS: Information from the NSW prison methadone program was used to construct a model of the costs of the program. The information was combined with data from a randomised controlled trial of provision of prison methadone in NSW. The total program cost was estimated from the perspective of the treatment provider/funder. The cost per heroin free day, compared with no prison methadone, was estimated. Assumptions regarding resource use were tested through sensitivity analysis. RESULTS: The annual cost of providing prison methadone in NSW was estimated to be 2.9 million Australian dollars (or 3,234 Australian dollars per inmate per year). The incremental cost effectiveness ratio is 38 Australian dollars per additional heroin free day. CONCLUSIONS: From a treatment perspective, prison methadone is no more costly than community methadone, and provides benefits in terms of reduced heroin use in prisons, with associated reduction in morbidity and mortality.     

A randomised trial of the cost effectiveness of buprenorphine as an alternative to methadone maintenance treatment for heroin dependence in a primary care setting

BACKGROUND AND AIM: Buprenorphine offers an alternative to methadone in the treatment of heroin dependence, and has the advantage of allowing alternate-day dosing. This study is the first to examine the cost effectiveness of buprenorphine as maintenance treatment for heroin dependence in a primary care setting using economic and clinical data collected within a randomised trial. STUDY DESIGN AND METHODS: The study was a randomised, open-label, 12-month trial of 139 heroin-dependent patients in a community setting receiving individualised treatment regimens of buprenorphine or methadone. Those who were currently on a methadone program (n = 57; continuing therapy subgroup) were analysed separately from new treatment recipients (n = 82; initial therapy subgroup). The study took a broad societal perspective and included health, crime and personal costs. Data on resource use and outcomes were a combination of clinical records and self report at interview. The main outcomes were incremental cost per additional day free of heroin use and per QALY. An analysis of uncertainty calculated the likelihood of net benefits for a range of acceptable money values of outcomes. All costs were in 1999 Australian dollars (DollarA). RESULTS: The estimated mean number of heroin-free days did not differ significantly between those randomised to methadone (225 [95% CI 91, 266]), or buprenorphine (222 [95% CI 194, 250]) over the year of the trial. Buprenorphine was associated with an average 0.03 greater QALYs over 52 weeks (not significant). The total cost was DollarA 17,736 (95% CI -DollarA 2981, DollarA 38,364) with methadone and DollarA 11,916 (95% CI DollarA 7697, DollarA 16,135) with buprenorphine; costs excluding crime were DollarA 4513 (95% CI DollarA 3495, DollarA 5531) and DollarA 5651 (95% CI DollarA 4202, DollarA 7100). With additional heroin-free days as the outcome, and crime costs included buprenorphine has a lower cost but less heroin-free days. If crime costs are excluded buprenorphine has a higher cost and worse outcome than methadone. With additional QALYs as the outcome, the cost effectiveness of buprenorphine is DollarA 39,404 if crime is excluded, but buprenorphine is dominant if crime is included. CONCLUSIONS: The trial found no significant differences in costs or outcomes between methadone and buprenorphine maintenance in this particular setting. Although some of the results suggest that methadone may have a cost advantage, it is difficult to infer from the trial data that offering buprenorphine as an alternative would have a significant effect on total costs or outcomes. The point estimates of costs and outcomes suggest that buprenorphine may have an advantage in those initiating therapy. The confidence intervals were wide, however, and the likelihood of net benefits from substituting one treatment for another was close to 50%.     

Reductions in criminal convictions after addiction treatment: 5-year follow-up

Changes in criminal convictions were investigated among 1075 clients admitted to 54 drug misuse treatment services across England as part of the National Treatment Outcome Research Study (NTORS). Convictions data during the year prior to treatment, and at 1 year, 2 years, and 5 years after treatment intake were collected from the Home Office Offenders' Index, a national database of all convictions in adult and youth courts. Clinical data were collected by face-to-face interviews at intake to treatment, and at follow-up 1 year, 2 years, and 4-5 years after admission to treatment. During the year prior to treatment, 34% of the sample had been convicted of at least one offence. Conviction rates at all follow-up points were significantly lower than at intake. During the year prior to the 5-year follow-up, 18% of the sample had been convicted of at least one offence. Statistically significant reductions in the mean number of convicted offences were also found between treatment intake and 5-year follow-up. Reductions in convictions were found for acquisitive, drug selling, and violent crimes. Reductions in crime were associated with reductions in regular heroin use, age, and with stable housing. The results replicate previously reported findings of crime reductions among the NTORS cohort as indicated by self-reported measures of offending behaviour. The observed reductions in crime among drug misusers after treatment represent substantial changes in behaviour and have considerable personal, social and clinical significance. Reduced criminality also provides substantial economic benefits to society.     

社区海洛因依赖者美沙酮维持治疗的效果评估

目的:探讨美沙酮维持治疗在中国实施的可行性和有效性。方法:对海洛因依赖者开展美沙酮维持治疗试验性项目并定期开展小组心理干预、个别心理咨询和相关的支持活动。项目实施1a后,采用自制问卷对美沙酮维持治疗前后的效果进行评估,并将结果与37名社区海洛因依赖者进行比较。结果:美沙酮维持治疗后,维持者自我报告使用海洛因的比例由治疗前的100·0%下降为64·4%,其中,每天使用3次以上海洛因者由维持治疗前的50·0%降为0;对照组为43·2%。维持者的总违法犯罪率与维持治疗前和对照组比较,分别下降了4·6%和15·3%。维持者以注射方式吸毒的比例显著低于项目开展前和对照组(P<0·01),而从不使用安全套的比例明显少于项目前和对照组(P<0·01)。结论:在我国的海洛因依赖者中开展美沙酮维持治疗对于减少非法毒品的使用,降低违法犯罪率和减少感染艾滋病的高危行为是有效的。     

The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime

The current study aimed to model the effect of Australia's first Medically Supervised Injecting Centre (MSIC) on acquisitive crime and loitering by drug users and dealers. The effect of the MSIC on drug-related property and violent crime was examined by conducting time series analysis of police-recorded trends in theft and robbery incidents, respectively. The effect of the MSIC on drug use and dealing was examined by (a) time series analysis of a special proxy measure of drug-related loitering; (b) interviewing key informants; and (c) examining trends in the proportion of Sydney drug offences that were recorded in Kings Cross. There was no evidence that the MSIC trial led to either an increase or decrease in theft or robbery incidents. There was also no evidence that the MSIC led to an increase in 'drug-related' loitering at the front of the MSIC after it opened, although there was a small increase in 'total' loitering (by 1.2 persons per occasion of observation). Trends in both 'drug-related' and 'total' loitering at the front of the MSIC steadily declined to baseline levels, or below, after it opened. There was a very small but sustained increase in 'drug-related' (0.09 persons per count) and 'total' loitering (0.37 persons per count) at the back of the MSIC after it opened. Key informant interviews noted an increase in loitering across the road from the MSIC but this was not attributed to an influx of new users and dealers to the area. There was no increase in the proportion of drug use or drug supply offences committed in Kings Cross that could be attributed to the opening of the MSIC. These results suggest that setting up an MSIC does not necessarily lead to an increase in drug-related problems of crime and public loitering.     

贵州美沙酮维持治疗受治者间隔服药特点的观察

目的:了解贵州省8家美沙酮维持治疗(MMT)门诊的受治者间隔服药特点。方法:采用队列研究设计,从2006年6月到2007年6月,对1003名贵州省8家MMT门诊受治者进行服药情况调查。结果:有87.1%、74.9%、60.6%和50.3%受治者分别有过连续3d、7d、15d和30d间隔不到门诊服药情况。结论:MMT受治者间隔服药现象十分普遍。     

Prescribing drug of choice to opiate dependent drug users: a comparison of clients receiving heroin with those receiving injectable methadone at a West London drug clinic

Fifty-eight long-term treatment resistant opiate-dependent drug users were offered the choice of receiving injectable heroin or injectable methadone at a West London drug clinic. Drugs were dispensed on-site at the clinic with weekend take-home. There was no routine ongoing supervised injecting. A ceiling dose of 200 mg/day of heroin or methadone was set. One-third chose injectable methadone. Compared to those choosing heroin, these drug users were less likely to have used heroin or crack/cocaine before entering treatment, and were more likely to have previously received treatment with injectable methadone. Drug users reported choosing methadone because it was their primary drug of addiction, and compared with heroin has a longer duration of action and increased strength. Problems with each drug were reported: those choosing heroin complained that the upper dose limit was too low to maintain them adequately, and some receiving methadone complained of discomfort while injecting intravenously. While those choosing each drug had different baseline characteristics, both groups were well retained in treatment and at 3 months made significant reductions in drug use and crime, which were sustained over the 12-month follow-up period. There was no significant difference between treatment outcome between each group. There is an urgent need to conduct randomized controlled trials to establish the effectiveness of prescribing injectable methadone and heroin to inform policy and practice.     

Effect of methadone maintenance treatment on heroin craving, a literature review

Despite agreement that methadone maintenance treatment (MMT) is an effective and safe option for treatment of heroin dependence, there have been controversies about its effect on heroin craving. A systematic literature review of the PubMed database was used to find studies eligible for inclusion in the study. The authors present the results of 16 articles that met all inclusion criteria. Overall, 7 studies reported that methadone could reduce heroin craving, 4 studies reported that patients in MMT are still at risk of having heroin craving, 1 study reported that methadone could increase heroin craving, and 4 studies reported that methadone has a neutral effect on heroin craving. One may speculate from these data that methadone may help with heroin craving, but patients in MMT may still be at risk of cue-induced heroin cravings. Methadone provides a helpful tool for reducing some components of craving and risk of relapse for patient receiving MMT.     

Treatment retention in adolescent patients treated with methadone or buprenorphine for opioid dependence: a file review

The aim of this study was to compare retention and re-entry to treatment between adolescent subjects treated with methadone, those treated with buprenorphine, and those treated with symptomatic (non-opioid) medication only. We used a retrospective file review of all patients aged less than 18 at first presentation for treatment for opioid dependence. The study was conducted at the Langton Centre, Sydney, Australia, an agency specialising in the treatment of alcohol and other drug dependency. Sixty-one adolescents (age range 14 - 17 years at the time of commencing treatment); mean reported age of initiation of heroin use was 14 +/- 1.3 years (range 11 - 16). Sixty-one per cent were female. The first episode of treatment was methadone maintenance in 20 subjects, buprenorphine in 25, symptomatic medication in 15; one patient underwent assessment only. These 61 subjects had a total of 112 episodes of treatment. Subjects treated with methadone had significantly longer retention in first treatment episode than subjects treated with buprenorphine (mean days 354 vs. 58, p<0.01 by Cox regression) and missed fewer days in the first month (mean 3 vs. 8 days, p<0.05 by ttest). Subsequent re-entry for further treatment occurred in 25% of subjects treated with methadone, 60% buprenorphine and 60% symptomatic medications. Time to re-entry after first episode of buprenorphine treatment was significantly shorter than after methadone treatment (p<0.05 by Kaplan - Meier test). Methadone maintenance appears to have been more effective than buprenorphine at preventing premature drop-out from treatment of adolescent heroin users.     

Changes in cocaine use after entry to methadone treatment.

A cohort sample of 93 addicts admitted to methadone maintenance in four clinics was followed-up for one year to determine change, and predictors of change, in cocaine use. Any use of cocaine in the preceding month decreased from 84% of subjects at admission to 66% at follow-up, and mean days of cocaine use per month for those still using decreased from 16 days to 9 days. Any drug injection in the preceding month decreased from 100% of subjects at admission to 39% at follow-up, among those remaining in the program. Continuance/cessation of cocaine use was not associated with program retention, but cocaine users were more likely to be administratively discharged. Reported symptoms of depression and speedballing at admission were significant predictors of continuance/cessation of cocaine use at follow-up. State-of-the-art cocaine abuse treatment, with attention to treatment of depression, would enhance the value of methadone maintenance for patients with dual heroin/cocaine addiction.