Heroin assisted treatment
Encyclopedia
Heroin assisted treatment, or diamorphine assisted treatment, refers to the prescribing of synthetic, injectable heroin to opiate
addicts that do not benefit from or cannot tolerate treatment with one of the established drugs used in opiate replacement therapy
like methadone
or buprenorphine
. For this group of patients, heroin assisted treatment has proven superior in improving their social and health situation. It has also been shown to save money, despite its high costs, as it significantly reduces costs incurred by trials, incarceration, health interventions and delinquency.
Heroin assisted treatment is fully a part of the national health system in Switzerland
, Germany
, the Netherlands
, Denmark
and the United Kingdom
. Additional trials are being carried out in Canada
and Belgium
.
". Because of the lack of large-scale trials, only anecdotal evidence existed as to the efficacy of the treatment. This changed in 1994 when Switzerland, against strong opposition from U.N. drug control authorities, started large-scale trials on the potential use of diamorphine as a maintenance drug. They proved diamorphine to be a viable maintenance drug which has shown equal or better rates of success than methadone
in terms of assisting long-term users establish stable, crime-free lives. These results encouraged countries like Germany
and the Netherlands to conduct their own trials and finally to include heroin assisted treatment fully as a part of the national health system. In recent years the British are also again moving toward heroin maintenance as a legitimate component of their National Health Service
.
symptoms in between injections, most patients are given an additional daily dose of methadone
.
In the Netherlands
, both injectable Diamorphine HCl as injectable salt in dry ampoules as well as Heroin base with 5-10% caffeine for vaporisation are available, both are to be taken twice daily in a supervised setting and will be accompanied with a daily take home dosage of methadone for the evening.
In Switzerland
patients may be allowed to appear only once a day and receive part of their diamorphine in pill form for oral consumption. This is possible only after a six-month period and is usually granted only if necessary to hold down a job.
, have criticised heroin assisted treatment along with other harm reduction
strategies for allegedly creating the perception that certain behaviors can be partaken safely, such as illicit drug use, claiming that this may lead to an increase in that behavior by people who would otherwise be deterred.
However in Switzerland the incidence of heroin abuse has declined sharply since the introduction of heroin assisted treatment. As a study published in The Lancet
concluded:
Also, the notion that patients in heroin assisted treatment are enabled to maintain "destructive behavior" contradicts the findings that patients significantly recover in terms of both their social and health situation. Many participants in the German "Heroinstudie" were able to find employment (~ 40%), some even started a family after years of homelessness and delinquency.
Opiate
In medicine, the term opiate describes any of the narcotic opioid alkaloids found as natural products in the opium poppy plant.-Overview:Opiates are so named because they are constituents or derivatives of constituents found in opium, which is processed from the latex sap of the opium poppy,...
addicts that do not benefit from or cannot tolerate treatment with one of the established drugs used in opiate replacement therapy
Opiate replacement therapy
Opioid replacement therapy is the medical procedure of replacing an illegal opioid drug such as heroin with a longer acting but less euphoric opioid, usually methadone or buprenorphine, that is taken under medical supervision. In some countries patients may be treated with slow-release morphine...
like methadone
Methadone
Methadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937...
or buprenorphine
Buprenorphine
Buprenorphine is a semi-synthetic opioid that is used...
. For this group of patients, heroin assisted treatment has proven superior in improving their social and health situation. It has also been shown to save money, despite its high costs, as it significantly reduces costs incurred by trials, incarceration, health interventions and delinquency.
Heroin assisted treatment is fully a part of the national health system in Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
, Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
, the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
, Denmark
Denmark
Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. Denmark...
and the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
. Additional trials are being carried out in Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
and Belgium
Belgium
Belgium , officially the Kingdom of Belgium, is a federal state in Western Europe. It is a founding member of the European Union and hosts the EU's headquarters, and those of several other major international organisations such as NATO.Belgium is also a member of, or affiliated to, many...
.
History
The British have had a system of heroin maintenance since the 1920s. For decades it supplied a few hundred addicts nationwide, most of whom were doctors themselves. It was de-emphasized considerably during the 1960s-1980s as a result of the U.S. led "war on drugsWar on Drugs
The War on Drugs is a campaign of prohibition and foreign military aid and military intervention being undertaken by the United States government, with the assistance of participating countries, intended to both define and reduce the illegal drug trade...
". Because of the lack of large-scale trials, only anecdotal evidence existed as to the efficacy of the treatment. This changed in 1994 when Switzerland, against strong opposition from U.N. drug control authorities, started large-scale trials on the potential use of diamorphine as a maintenance drug. They proved diamorphine to be a viable maintenance drug which has shown equal or better rates of success than methadone
Methadone
Methadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937...
in terms of assisting long-term users establish stable, crime-free lives. These results encouraged countries like Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
and the Netherlands to conduct their own trials and finally to include heroin assisted treatment fully as a part of the national health system. In recent years the British are also again moving toward heroin maintenance as a legitimate component of their National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
.
Modes of operation
While the British system trusts the patient with weekly prescriptions, other countries had to impose stronger restrictions to avoid deviation to the illegal market. Patients there have to appear twice a day at a treatment center where they inject their doses of diamorphine under the supervision of medical staff. To avoid withdrawalWithdrawal
Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...
symptoms in between injections, most patients are given an additional daily dose of methadone
Methadone
Methadone is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937...
.
In the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
, both injectable Diamorphine HCl as injectable salt in dry ampoules as well as Heroin base with 5-10% caffeine for vaporisation are available, both are to be taken twice daily in a supervised setting and will be accompanied with a daily take home dosage of methadone for the evening.
In Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
patients may be allowed to appear only once a day and receive part of their diamorphine in pill form for oral consumption. This is possible only after a six-month period and is usually granted only if necessary to hold down a job.
Criticism
Critics, such as the Drug Free America FoundationDrug Free America Foundation
The Drug Free America Foundation or DFAF is a 501 non-profit organization that currently describes itself as "committed to developing, promoting and sustaining global strategies, policies and laws that will reduce illegal drug use, drug addiction, drug-related injury and death." The organization...
, have criticised heroin assisted treatment along with other harm reduction
Harm reduction
Harm reduction refers to a range of public health policies designed to reduce the harmful consequences associated with recreational drug use and other high risk activities...
strategies for allegedly creating the perception that certain behaviors can be partaken safely, such as illicit drug use, claiming that this may lead to an increase in that behavior by people who would otherwise be deterred.
However in Switzerland the incidence of heroin abuse has declined sharply since the introduction of heroin assisted treatment. As a study published in The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
concluded:
Also, the notion that patients in heroin assisted treatment are enabled to maintain "destructive behavior" contradicts the findings that patients significantly recover in terms of both their social and health situation. Many participants in the German "Heroinstudie" were able to find employment (~ 40%), some even started a family after years of homelessness and delinquency.