Heroin-Assisted Treatment

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Page last updated June 9, 2020 by Doug McVay, Editor/Senior Policy Analyst.

11. Safe Injection Sites and International Drug Control Treaties

"23. It might be claimed that this approach [drug injection rooms] is incompatible with the obligations to prevent the abuse of drugs, derived from article 38 of the 1961 Convention and article 20 of the 1971 Convention. It should not be forgotten, however, that the same provisions create an obligation to treat, rehabilitate and reintegrate drug addicts, whose implementation depends largely on the interpretation by the Parties of the terms in question. If, for example, the purpose of treatment is not only to cure a pathology, but also to reduce the suffering associated with it (like in severe-pain management), then reducing IV drug abusers exposure to pathogen agents often associated with their abuse patterns (like those causing HIV-AIDS, or hepatitis B) should perhaps be considered as treatment. In this light, even supplying a drug addict with the drug he depends on could be seen as a sort of rehabilitation and social reintegration, assuming that once his drug requirements are taken care of, he will not need to involve himself in criminal activities to finance his dependence."

"Flexibility of Treaty Provisions as Regards Harm Reduction Approaches," Legal Affairs Section UNDCP (Vienna, Austria: International Narcotics Control Board, September 30, 2002), p. 5.

12. Human Rights and Heroin-Assisted Treatment

"Heroin prescription is consistent with a number of state responsibilities under international human rights instruments. The Universal Declaration of Human Rights states that 'everyone has the right to a standard of living adequate for the health and wellbeing of himself … including … medical care and necessary social services.'24 Similarly, the International Convention on Economic, Social and Cultural Rights (ICESCR) recognizes the 'right of everyone to the highest attainable standard of physical and mental health.'25 The UNAIDS/OHCHR International Guidelines on HIV/AIDS and Human Rights recommend that states ensure the 'widespread availability of qualitative prevention measures and services, adequate HIV prevention and care information' in order to protect the human rights of people living with HIV/AIDS and stem the spread of the virus." [Note: Ellipses used in source document.]

Canadian HIV/AIDS Legal Network, "Legislating on Health and Human Rights: Model Law on Drug Use and HIV/AIDS Module 8: Heroin prescription programs," (Tornoto, Ontario: 2006), p. 9.

13. Political Opposition to Heroin-Assisted Treatment

"The existing interference and non-evidence-based opposition from politicians and care providers, who refuse to acknowledge the limitations of methadone maintenance and the superiority of prescribed heroin in selected populations, is arguably unethical. Denying effective second-line therapy to those in need ultimately serves to condemn many users of illicit heroin to the all too common outcomes of untreated heroin addiction, including HIV infection or death from overdose."

Kerr, Thomas; Montaner, Julio SG; and Wood, Evan, "Science and politics of heroin prescription," The Lancet (London, United Kingdom:May 29, 2010) Vol. 375, Issue 9729, p. 1850.

14. History of Heroin-Assisted Treatment

"The emerging consensus is that heroin is a treatment for a limited number of illicit-drug users who do not do well with other medicines. Historically, however, heroin was the main 'drug of choice' for treatment. In the 1920s and earlier in Britain, it was the treatment or maintenance drug for compliant middle-class addicts, those who accepted the authority of the doctor to prescribe to them. The prescription of heroin was the basis of the so-called British system, which operated until the 1960s.6 This was not the case in the United States. The inability to conduct the NAOMI trial in the United States reflects a historically different attitude toward the medical prescription of heroin to addicts; this prohibition dates back to the implementation of the 1914 Harrison Narcotics Act before World War I. Doctors were prosecuted thereafter if they prescribed heroin for addicts."

Berridge, Virginia, "Heroin Prescription and History," New England Journal of Medicine (Boston, MA: Massachusetts Medical Society, August 20, 2009) Volu. 361, Issue 8, p. 820.

15. Research Ethics

"The most widely accepted document outlining ethical standards for research at the international level is the Declaration of Helsinki [36]. There is a crucial section, paragraph 30, of the document that is pertinent to research on heroin treatment for addiction. It reads:
"'At the conclusion of the study, every patient entered into the study should be assured of access to the best proven prophylactic, diagnostic and therapeutic methods identified by the study'[37]
"The main motive for this portion of the international research guidelines is to prevent the sponsors of research trials (government, university, hospital or private) and physician collaborators from initiating research on subjects who would otherwise be unable to access the treatment offered in the research and then taking away the treatment when the research schedule is complete [36]."

Small, Dan, and Drucker, Ernest, "Policy Makers Ignoring Science Scientists Ignoring Policy: The Medical Ethical Challenges of Heroin Treatment," Harm Reduction Journal (London, United Kingdom: May 2006), Vol. 3, p. 13.