Executive Summary

Introduction: Heroin use, with its associated harms, represents a serious public health concern, and generates many challenges for treatment providers. In Australia, an estimated 74,000 individuals are thought to be heroin dependent, with more people treated for dependence on opioids than any other drug class. Despite this, little is known about how effective the main treatment options are in practice.

The Australian Treatment Outcome Study (ATOS) is the first large scale longitudinal study of treatment outcome for heroin dependence to be conducted in Australia. ATOS is coordinated by the National Drug and Alcohol Research Centre (NDARC), and is conducted in collaboration with the Drug and Alcohol Services Council (DASC) and Turning Point Alcohol and Drug Centre.

The aims of ATOS are:

To describe the characteristics of people seeking treatment for problems associated with heroin use in Australia;
To describe the treatment received; and
To examine treatment outcomes and costs at 3 and 12 months after commencement of treatment.

The current report presents data from the three month follow-up interview of subjects in the New South Wales arm of the study.

Method: Nineteen treatment agencies were randomly selected from within the three main treatment modalities (methadone/buprenorphine maintenance therapy; detoxification; residential rehabilitation) stratified by area health serv ice. Five hundred and thirty five individuals entering treatment and 80 heroin users not seeking treatment were recruited into the study and interviewed by NDARC staff using a structured questionnaire. 89% of the treatment sample and 83% of the non-treatment sample were successfully recontacted and interviewed at three months. Data was collected on a variety of domains including: treatment experiences; heroin and other drug use, mental health and criminal activity.

Results:

89% of the treatment sample and 83% of the non-treatment sample were successfully recontacted and interviewed three months after entering treatment. There were no differences between those re-interviewed and those lost to follow up in terms of heroin use at baseline.
There were substantial reductions in heroin and other drug use across all three treatment samples. For example, the one month prevalence of heroin abstinence rose from 1% at baseline to 53% at three months across treatment modalities. While there was also an increase in one month abstinence in the non-treatment sample, this was considerably less marked than in the treatment samples (from 0% to 20%). The reduction in heroin use among the treatment samples was paralleled by reductions in the use of other drugs, suggesting that subjects were not simply substituting heroin use with the use of other drugs but were, in fact, reducing their overall drug consumption. Confirmation of self-reported heroin use by means of hair analysis revealed excellent validity of self-report.
Reductions in drug use were paralleled by improvements in both physical and mental health, assessed using the SF-12.
There were notable reductions in the percentages of subjects reporting committing any crime or that their major source of income was from crime across the treatment samples.

Conclusion: The high rate of sample retention and subject participation attests to the feasibility of conducting longer term follow-up studies with groups of individuals entering treatment for heroin dependence. Three months after entering treatment there were substantial reductions in heroin use, other drug use, and in criminal activity. In addition, there were substantial improvements in mental and physical health. These results confirm, for the first time in a naturalistic Australian setting, the results of previous clinical trials and overseas research indicating that treatment for heroin dependence is associated with marked reductions in drug use, criminal activity and in substantial improvements in mental health in the short term. The twelve month follow-up results will be reported in future reports.

Citation: Ross, J., Lynskey, M., Teesson, M., Darke, S., Havard, A., Mills, K., Williamson, A., Hetherington, K. and Fairbairn, S. (2003) Three month outcomes for the treatment of heroin dependence: Findings from the Australian Treatment Outcome Study (ATOS) News South Wales, Sydney: National Drug and Alcohol Research Centre.