To Give Or Not To Give Heroin To Addicts

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Main Category: Alcohol / Addiction / Illegal Drugs
Article Date: 13 Jan 2008 - 0:00 PDT

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Should heroin addicts who are hard to treat be given heroin? A head-to-head (debate) looks at this topic in this week's issue of the British Medical Journal (BMJ).

Yes

Jurgen Rehm, Centre for Addiction and Mental Health, Toronto, and Benedikt Fischer, University of Victoria, British Columbia explain that maintenance treatment with heroin is appropriate for heroin addicts under specific circumstances.

Trials carried out in Germany, the Netherlands, and Switzerland have found heroin assisted maintenance treatment to be practicable and effective for people who are resistant to treatment - it was also found to be more cost-effective than methadone maintenance treatment. In the United Kingdom, where heroin treatment has been an option for many decades, the practice is still controversial.

They ask why heroin should not be used as one such pharmacological agent if maintenance treatment is generally justifiable.

Safety for both the patient and the general public has been cited as one reason. However, according to the Swiss study, mortality of patients in heroin assisted maintenance programs is low, and less than for patients in other maintenance programs.

Rehm and Fischer see no compelling reason why heroin assisted maintenance treatment should not be included as part of a comprehensive treatment system for heroin dependence.

No

Neil McKeganey, Professor of Drug Misuse Research, University of Glasgow, says that prescribing heroin to a heroin addict is not treating the addiction, rather it is treating the effects of misuse. He adds that the evidence regarding heroin prescribing is not conclusive at all. It may cost three to four times more to treat an addict with heroin than with methadone.

There is also a risk that doctors end up prescribing increasing quantities of the drug.

McKeganey explains that research has indicated that with the right services in place it is possible to achieve more than just stabilizing the addicts' continued drug use through the prescribing route. He cites a Scottish study that found that 29.4% of addicts who receive residential rehabilitation did not take heroin for at least 90 days, compared to just 3.4% of those on methadone maintenance.

According to other studies, the addict really does want a service that helps him/her become drug free. It is the duty of health services to make sure they are supporting the addict's attempts to become free of the drug. Services have to be extremely cautious about any addition to a policy that may be seen as a path to maintaining instead of reducing an addict's dependence, he concludes.

"Should heroin be prescribed to heroin misusers? Yes"
Jürgen Rehm, Benedikt Fischer
BMJ 2008;336:70 (12 January), doi:10.1136/bmj.39421.593692.94
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"Should heroin be prescribed to heroin misusers? No"
Neil McKeganey
BMJ 2008;336:71 (12 January), doi:10.1136/bmj.39422.503241.AD
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Written by - Christian Nordqvist
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