Heroin for Heroin Addiction

Getting your fix at the doctor’s office.

A group of Canadian researchers has demonstrated the truth of a practice commonly used in European countries like The Netherlands and Switzerland: Heroin can be an effective treatment for chronic, relapsing heroin addicts. Published in the New England Journal of Medicine, the study is “the first rigorous test of the approach performed in North America,” according to a New York Times article by Benedict Carey.

In the study, 226 patients were randomly assigned to oral methadone therapy or injectable diacetylmorphine, the primary active ingredient in heroin, over a 12-month period. The “rate of retention in addiction treatment” was 88 percent for the diacetylmorphine group, compared to 54 percent for the methadone group. The “reduction in rates of illicit-drug use” was 67 percent for the heroin group and 48 percent for the methadone group.

Using doctor-prescribed heroin has two advantages, some researchers believe. It gets around the problem of addicts who don’t like the effect of methadone and therefore don’t take it as prescribed. Moreover, as European countries have demonstrated, it brings treatment-resistant opiate addicts into regular contact with physicians and medical treatment professionals, thereby keeping them away from drug dealers and out of jail.

The downside is equally obvious. It keeps addicts hooked on heroin, and may even exacerbate their addiction by providing a higher quality drug. Furthermore, it runs against the prevailing North American notion that heroin should be illegal, period. Certainly, doctors have no business prescribing it to active addicts, critics argue. Furthermore, the risk of overdose or seizure is always present.

According to senior author Martin Schechter of the University of British Columbia’s School of Population and Public Health, as quoted in the New York Times: “The main finding is that for this group that is generally written off, both methadone and prescription heroin can provide real benefits.”

In an editorial accompanying the journal article, Virginia Berridge of the London School of Hygiene and Tropical Medicine cautioned that “the rise and fall of methods of treatment in this controversial area owe their rationale to evidence, but they also often owe more to the politics of the situation.”

At the end of the 19th Century in America, opium was widely prescribed as a cure for alcoholism. For opium addiction, the treatment was often alcohol.

Photo Credit: www.steps2rehab.com

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Harm Reduction Scorecard

A look at drug strategies worldwide.

A fascinating study released earlier this year by the International Harm Reduction Association (IHRA) provides a snapshot of the staggering country-by-country variations in drug law and policy across the globe.

While Western Europe and North America have in place a solid base of operational heroin substitution therapies, such as methadone, these same Western countries have fallen behind in prison addiction programs, including all-important needle exchanges.

Countries lacking widespread access to heroin substitution programs include Russia, Afghanistan, Pakistan, Cambodia, and most of Latin America with the exception of Mexico. These are also, coincidentally or not, all regions of substantial opium cultivation.

As it turns out, every major nation except South Africa—where the ravages of HIV are all too evident--has put in place needle and syringe exchange programs of one scope or another, in at least one location in the country.

Interestingly, the IHRA report, titled “Harm Reduction Policy and Practice Wordwide,” finds that some of the countries with the most active needle exchange programs in prisons include Armenia, Kyrgyzstan, Romania—and Iran, which also offers heroin substitution therapy in prisons. Notable countries lacking widespread needle exchange programs in prisons include the United States, Latin America, and portions of Western Europe.

Finally, regarding the most radical category in the harm reduction arsenal—drug consumption rooms, also known as safe injection facilities—the world has been significantly slower to adopt this approach to the public consumption of injectable drugs. The document lists the existence of drug consumption rooms in Canada, Australia, Germany, Norway, the Netherlands, Spain, and Switzerland.

The report, prepared by Catherine Cook, a Research Analyst with IHRA, notes that the listings do not indicated “the scope, quality or coverage of services.” And while almost all countries have national policy documents that make reference to harm reduction policies for health or drug-related policy, strategies vary widely.

“Of particular interest here is the US,” the report notes, “which includes harm reduction in its national HIV and hepatitis C strategy documents, but not in those relating to drug policy.”


Graphic Credit: Bristol Drugs Project


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