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RIOTT: Three site trial of injectable opiate prescribing
Nicola Metrebian, Senior Research Fellow, and Teodora Groshkova, Research Fellow, and Vikki Charles, Research Fellow, National Addiction Centre, Institute of Psychiatry, Kings College London

Abstract
Injectable treatment has been a feature of UK drug treatment (albeit rare and dispensed without supervision) for over 40 years. Conventional treatment using oral methadone has been demonstrated to be effective for most heroin users entering treatment. However there are a significant minority who despite receiving conventional treatment continue to inject illicit heroin. A randomised controlled trial - RIOTT - began in 2005 to compare the safety, efficacy, and cost effectiveness of injectable opioid treatment (heroin and methadone) with "optimised" oral methadone.  The trial is being conducted in new supervised injectable maintenance clinics and aims to establish whether patients currently failing to benefit from oral methadone maintenance significantly improve with injectable treatment.

150 subjects, at three treatment sites, are randomly allocated to one of three conditions - either injectable heroin, injectable methadone, or high dose optimised oral methadone treatment. Entry criteria was based on national guidance on patient eligibility criteria for injectable opiate treatment including that the subject is a long term opiate dependent drug injector, and despite receiving conventional oral maintenance treatment continues to regularly inject street heroin. Subjects are followed up for six months.

Problems recruiting to the trial will be presented together with the drug use and treatment histories, and the health and social status of subjects participating in the trial.

Recruitment was slower than expected, partly due to it taking longer than expected to set up the new supervised clinics and partly due to the low number of referrals to these clinics. Slow recruitment has been a feature of previous national and international trials. The issues around recruiting hard to treat drug users in the UK trial will be examined in the context of recruitment issues experienced by other similar trials.

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Biography
Dr Nicola Metrebian is a Senior Research Fellow at the National Addiction Centre and is the senior researcher on RIOTT. She has spend over a decade researching the feasibility and effectiveness of injectable opiate treatment.