Should heroin be prescribed to addicts?

In this week’s BMJ experts debate whether heroin should be prescribed to addicts who are difficult to treat.

Maintenance treatment with heroin is appropriate for heroin misusers under certain circumstances, argue Jürgen Rehm from the Centre for Addiction and Mental Health in Toronto and Benedikt Fischer from the University of Victoria, British Columbia.

They point to trials in Switzerland, the Netherlands and Germany, which found heroin assisted maintenance treatment feasible and effective for those resistant to treatment. They also found it to be cost effective compared with methadone maintenance treatment.

In the UK, heroin has also been a treatment option for heroin misusers for several decades, but the practice remains controversial.

So, if maintenance treatment is generally justifiable, why should heroin not be used as one such pharmacological agent, they ask"

One reason that has been cited is safety, both for the patient and for the general public. Yet results from the Swiss studies show that mortality among patients in heroin assisted maintenance programmes is low, and lower than for patients in other maintenance programmes.

Overall, say the authors, we see no convincing reason why heroin assisted maintenance treatment should not be part of a comprehensive treatment system for opioid dependence.

But Neil McKeganey, Professor of Drug Misuse Research at the University of Glasgow argues that prescribing heroin to heroin addicts is treating the effects of misuse not the addiction.

The evidence in relation to heroin prescribing is far from conclusive, he says, while the cost of treating an addict with heroin is estimated to be three to four times that of treating an addict with methadone.

Prescribing heroin to heroin addicts is also a risky strategy, which could lead to massive pressure on doctors to prescribe increasing amounts of the drug.

Research has shown that with the right services in place it is possible to do more than simply stabilise addicts’ continued drug use through the prescribing route, writes McKeganey. For example, a Scottish study found 29.4% of addicts who received residential rehabilitation were abstinent for at least 90 days compared with only 3.4% receiving methadone maintenance.

Other research has found that most addicts want services to help them become drug free. Health services therefore need to ensure that they are supporting addicts’ attempts to become drug free, and they need to be extremely cautious about any extension of a policy that could be seen as a route to maintaining rather than reducing an individual’s drug dependency, he concludes.

Source: British Medical Journal

   

• noman - Jan 11, 2008
  • Rank: 3 / 5 (2)
  Giving heroin to anyone who is having trouble getting off of it is a tragic mistake. I have a relative who has been an addict for far too long, you have to keep someone away from something until they no longer need it. As for replacements for calming and relaxing the detox symptoms, give them a cup of tea and tell them to shut up and stop winging. Nevermind health issues from dependancy, there are suppressors out there such as SUGAR, TEA, A STRAIGHT STATE OF MIND... Any doctor can say that their patient needs treatment of a special kind, but how can you treat someone by giving them what they don't need?!!!! I AM APPAULED, its disgusting, who ever heard of treating an insomniac by giving them a catastrophic amount of caffeine?????? It is the same but on another level. Any of you out there who don't know anything about heroin and the people who use it should shut up and listen to me, they do not need it, they need help, love, patience and respect. Not to be weaned off the stuff like a lab rat. Methadone is just as bad, and so are all the other replacement sedatives that have made my relative much sicker. Anyone that thinks more heroin will help needs to see what the person looks like when they have taken it, then you might decide that giving them more is maybe not such a good idea. GROW UP DOCTORS NURSES AND REHABILITATION CENTRES
  • report abuse
  • • Current rank
    • 1
    • 2
    • 3
    • 4
    • 5
• jburchel - Jan 11, 2008
  • Rank: 2 / 5 (3)
  How stupid. Yeah, this works out very well, just look at utopias like Amsterdam and Vancouver, BC where it was formally or practically legalized and crime has gone through the roof, addicts come from near and far to enjoy the wonders of the welfare state and eliminate their waste in allyways...
  • report abuse
  • • Current rank
    • 1
    • 2
    • 3
    • 4
    • 5