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Effects of Drug Substitution Programs on Offending Among Drug-Addicts

NCJ Number
Date Published
August 2009
40 pages

The authors of this meta-analysis worked to evaluate the effects of drug prescription and substitution programs on criminal behavior among participants; they suggested that if the results of their review support the conclusion that heroin maintenance reduces criminality, medical prescription of heroin could be an option in the treatment of severely addicted drug users with high criminal involvement whenever reductions in offending is among the priorities.


Drug abusers are generally more involved in crime, in particular property crime, than people who are not drug abusers. Substitution programs have been developed in order to improve drug users' quality of life and to decrease their criminal involvement. Several evaluations, but not all, have reported crime reductions following substitution therapies based on heroin and methadone prescription. This systematic review is aimed at gaining an overall picture on the respective effects of prescription of methadone vs. heroin and other substances. Sixty-six studies were considered, and 46 were selected for inclusion in the review. They separately assess the impact of methadone, buprenorphine, heroin, naltrexone, dihydrocodeine or Levo alpha-acetylmethadone substitution on the criminal behavior of opiates addicts. Meta-analytic techniques were used to identify overall effects of several substances. Heroin maintenance has been found to significantly reduce criminal involvement among treated subjects, and it is more effective in crime reduction than methadone maintenance. Methadone maintenance greatly reduces criminal involvement, but apparently not significantly more so than other interventions. Buprenorphine does not significantly reduce criminal behavior, although effects are positive, be it with respect to methadone or a placebo. Naltrexone treatment reduces criminality significantly more than behavior therapy or counselling. Buprenorphine and Naltrexone have been found to be promising, although few studies have been identified using these substances in maintenance treatment. Publisher Abstract Provided

Date Published: August 1, 2009