Does prescribing heroin to heroin addicts work?

Contact: Richard Lane
richard.lane@lancet.com
44-20-7611-4076
Lancet

Researchers from Switzerland report, in this week’s Lancet, success with a controversial heroin-assisted treatment programme for chronically addicted heroin addicts who failed to respond to traditional treatments.

Heroin addiction has serious adverse health consequences for the heroin addict, but also has an effect on society at large, through heroin-related crime, and the public nuisance that heroin addicts may cause. Treatment usually aims at stopping the addict’s craving for heroin, or prescribing a substitute, methadone, which has some of the effects of heroin. Many addicts drop out of any sort of treatment offered.

An alternative treatment for addicts is to prescribe limited amounts of heroin, along with other approaches to breaking the addiction. This approach had been used many years ago, and was reintroduced in Switzerland, a country where, during the 1980s and 1990s, there was an increase in the number of heroin addicts.

Swiss public-health authorities implemented various measures to treat heroin addiction, to improve the health of addicts, to protect society, and to counter drug-related crime. Some addicts did not respond to conventional measures, so in 1994, some centres tried prescribing heroin. In this week’s Lancet, Professor Jurgen Rehm and colleagues report the Swiss experience of heroin prescription over the past 6 years.

The researchers looked into the experiences of 1969 patients, treated in 21 centres. They found that 86% of addicts remained in heroin-prescription programmes for three months, 70% for a year, and 34% for 5 years or more. Benefits to those in this treatment programme, which included not only prescribing heroin, but also intensive efforts at rehabilitation, included a decrease in infections and mental disorders. The addicts social functioning also improved, and criminality decreased. Finally, use of illicit drugs, especially cocaine, was reduced.

The authors note that there is a similar programme of heroin prescription in the Netherlands, and comment that, “Heroin-assisted treatment in both countries is provided as an addition to a well-developed and versatile treatment system, and any study results should be considered against this background”.

In a commentary, Ernest Drucker from the Montefiore Medical Center in New York, USA, notes that the approach to treating heroin addiction by prescribing heroin is not new, but went out of fashion because of public and professional disapproval. Such disapproval is still widespread. He writes that, “The chorus of poorly informed criticism and misinformation that has greeted the Swiss heroin trials in the USA reveals the depth of this old conflict and underscores the importance of this report”.

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Contact: Prof Jurgen Rehm, Addiction Research Institute Zurich, Konradstr 32, CH 8031 Zurich, Switzerland; T) + 41 1 273 40 24, F) +41 1 273 4064; E) jtrehm@aol.com.

Dr Ernest Drucker, Department of Epidemiology and Social Medicine, Division of Public Health and Policy Research, Montefiore Medical Centre, Bronx NY 10467, USA; E) drucker@aecom.yu.edu.

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