Article

Heroin-assisted treatment as a response to the public health problem of opiate dependence

Department of Public Health Sciences, University of Toronto, McMurrich Bldg., 109C, Toronto, ON, M5S 1A8, Canada.
The European Journal of Public Health (Impact Factor: 2.46). 10/2002; 12(3):228-34. DOI: 10.1093/eurpub/12.3.228
Source: PubMed

ABSTRACT Injection drug use (involving the injection of illicit opiates) poses serious public health problems in many countries. Research has indicated that injection drug users are at higher risk for morbidity in the form of HIV/AIDS and Hepatitis B and C, and drug-related mortality, as well as increased criminal activity. Methadone maintenance treatment is the most prominent form of pharmacotherapy treatment for illicit opiate dependence in several countries, and its application varies internationally with respect to treatment regulations and delivery modes. In order to effectively treat those patients who have previously been resistant to methadone maintenance treatment, several countries have been studying and/or considering heroin-assisted treatment as a complementary form of opiate pharmacotherapy treatment. This paper provides an overview of the prevalence of injection drug use and the opiate dependence problem internationally, the current opiate dependence treatment landscape in several countries, and the status of ongoing or planned heroin-assisted treatment trials in Australia, Canada and certain European countries.

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    • "A Cochrane review of 8 trials of treatment with diacetylmorphine concluded that heroin assisted treatment for treatment refractory opioid users was associated with improved treatment retention, reduced illicit drug use, and less criminal activity (Ferri, Davoli, & Perucci, 2011). In England, diacetylmorphine has been available for patients non-responsive to methadone treatment (Berridge, 2009; Fischer et al., 2002). Switzerland implemented heroin-assisted treatment in 1994; a retrospective chart review found 1,969 individuals admitted to 21 clinics between January, 1994 and December, 2000 (Rehm et al., 2001). "
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    • "In fact, a study of maternal urine samples at delivery of 715 women in Florida showed 13.3% were positive for an illicit drug such as marijuana, cocaine, or opiates. Although among illicit substances, the prevalence of substance abuse among pregnant women was highest for marijuana, followed by cocaine [3], the prevalence of opioid dependence was on the rise between 1970 and 1980 [4] and an estimated 8 million people worldwide were reported to abuse opioids in 2003 [5]. Though men still outnumber women, the proportion of women continues to increase, and more than 70% of opioid-dependent women are of child-bearing age. "
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    • "With minor differences, the objective of these and other heroin-prescription trials has been to show that medically supervised heroin prescription helps treat those addicted individuals that have not benefited from methadone programs and with whom other treatments have failed (resistant heroin addicts). In general, the results obtained in different countries have shown that heroin-assisted treatment can help reduce the problem of illicit opiate dependence by drawing in new opiate users already undergoing treatment and, in turn, offering alternatives to those who have gained no benefit from other types of treatment [10]. Up to now, epidemiological attempts to evaluate comparatively these heroin-prescription programs, across countries, and even across individual practitioners, have proved as problematic as have been epidemiological attempts to evaluate needle exchanges [17]. "
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