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: 2.59). 10/2002; 12(3):228-34. DOI: 10.1093/eurpub/12.3.228
Source: PubMed


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.

Download full-text


Available from: Ambros Uchtenhagen,
225 Reads
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Racial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among Hispanics and non-Hispanic Blacks. A meta-analysis of international research concluded that among persons who inject drugs, racial and ethnic minorities were twice as likely to acquire an HIV infection, though there was great variation across the individual studies. To examine strategies to reduce racial/ethnic disparities among persons who inject drugs, we reviewed studies on injection drug use and its role in HIV transmission. We identified four sets of evidence-based interventions that may reduce racial/ethnic disparities among persons who inject drugs: HIV counseling and testing, risk reduction services, access to antiretroviral therapy, and drug abuse treatment. Implementation of these services, however, is insufficient in many countries, including the United States. Persons who inject drugs appear to be changing drug use norms and rituals to reduce their risks. The challenges are to (a) develop a validated model of how racial/ethnic disparities in HIV infection arise, persist, and are reduced or eliminated over time and (b) implement evidence-based services on a sufficient scale to eliminate HIV transmission among all persons who inject drugs. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    American Psychologist 05/2013; 68(4):274-285. DOI:10.1037/a0032745 · 6.87 Impact Factor
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pregnancy in opioid-dependent women is a major public health issue. Women who are afflicted by opioid addiction are a highly vulnerable group of patients frequently becoming pregnant unplanned and at risk of adverse pregnancy outcomes and peri-natal complications. Opioid agonist maintenance treatment is the best option for the majority of women. Ideally, early and closely monitored treatment in an interdisciplinary team approach including social workers, nurses, psychologists, psychiatrists, gynecologists, anesthesiologists, and pediatricians should be provided. The treatment of comorbid psychiatric conditions, the resolution of financial, legal, and housing issues, and the psychosocial support provided have a significant effect on optimizing pregnancy outcomes. This paper aims to update health professionals in the field of gynecology and obstetrics on the latest optimal treatment approaches for mothers suffering from opioid dependence and their neonates.
    Obstetrics and Gynecology International 02/2012; 2012(17):195954. DOI:10.1155/2012/195954
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In recent decades, studies have been made of the possible benefits of treatments using heroin, although qualitative methodologies have not usually been employed. In 2004, in Granada (Spain), a clinical experiment was launched: the Experimental Narcotics Prescription Programme in Andalusia (PEPSA). This project attempted to evaluate the effectiveness of intravenous heroin and orally-administered methadone prescription for long-term socially-excluded opiate addicts for whom other treatments have failed. The research described herein is qualitative and has been carried out within the framework of the aforementioned experiment. The objective was to discover the attitudes, opinions and experiences of patients (and relatives) once they had been included in the program and are receiving heroin in a therapeutic environment. Focused ethnographic procedures were used to establish the study population. During the field work, we carried out in-depth interviews and observations using 21 patients and relatives. Analysis was carried out by a team according to grounded theory. Our results show how the treatment process and the administering of heroin in a therapeutic context manages to break the habit of consuming heroin obtained illegally, thus changing the significance given to the substance and bringing about improvements in aspects such as the workplace, family relations and physical and mental health. The move from 'substance addiction' to chronic 'illness' upon beginning the treatment provides a chance for a population with a long history of rejection and exclusion to become part of society once again.
    Drug and Alcohol Review 04/2009; 28(2):186-95. DOI:10.1111/j.1465-3362.2008.00015.x · 1.55 Impact Factor
Show more