Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack

First published: 10 May 2019 | Last updated: 20 May 2019

Aims: To analyse predictors of heroin abstinence in opiate substitution therapy (OST) based on frequency of crack use and its interactions with other predictors.


Design: Retrospective study.

Setting: A community drug service in London, UK.

Participants: Clinical records of 325 clients starting OST between 2010 and 2014 (197 methadone and 128 buprenorphine).

Measurements: Logistic regression models (a general model and separate models for methadone and buprenorphine) assessed demographic and clinical data as predictors of heroin abstinence at one year after treatment start.

Results: For the general model participants choosing methadone were more likely to use heroin at follow up (OR=2.36, 95% CI: 1.40 – 3.17) as were daily crack users on methadone (OR=2.62, 95% CI: 0.96  –  7.16). For the methadone model, only daily crack use predicted heroin use at follow up (OR = 2.62, 95% CI: 0.96  –  7.16). For buprenorphine, higher amounts of baseline heroin use, lower buprenorphine dose and daily drinking predicted heroin use at follow up (OR=0.85, 95% CI: 0.75 – 0.95; OR=1.31, 95% CI: 1.06 – 1.60 and OR=6.04, 95% CI: 1.26 – 28.92). Both the use of cannabis and depression increased likelihood of heroin abstinence for clients not using crack compared to occasional (OR=6.68, 95% CI: 0.37 – 119.59; OR=106.31, 95% CI: 3.41 – 3313.30) and daily (OR=57.49 (95% CI: 2.37 – 1396.46; OR=170.99 (95% CI: 4.61 – 6339.47) users.

Conclusions: Most of the predictors in the general model were found significant only in the buprenorphine but not in the methadone model, suggesting that a general model has little predictive value. For methadone, daily crack use predicted heroin use, and for buprenorphine, no crack use predicted heroin abstinence only when depression or cannabis use was present. Further research is needed to assess effective treatment approaches for the growing population of dual users.


Mary Bell MacLeod, Camden and Islington NHS Foundation Trust, London, UK Lynne Dawkins, London South Bank University, London, UK

Conflicts of interest:

No conflicts of interest

Dr Felicia Heidebrecht