Heroin-Assisted Treatment

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

21. Heroin Assisted Treatment Leads to a Reduction in Heroin Use

"We have shown that treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone. Furthermore, this difference was evident within the first 6 weeks of treatment.
"This randomised controlled trial of treatment with supervised injectable opiates builds on the findings of five randomised trials of supervised injectable heroin versus oral methadone."

Strang, John; Metrebian, Nicola; Lintzeris, Nicholas; Potts, Laura; Carnwath, Tom; Mayet, Soraya; Williams, Hugh; Zador, Deborah; Evers, Richard; Groshkova, Teodor; Charles, Vikki; Martin, Anthea; and Forzisi, Luciana, "Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial," The Lancet (London, United Kingdom: May 29, 2010) Vol. 375, Issue 9729, p.
http://www.thelancet.com/journ...

22. Heroin-Assisted Treatment and Retention in Treatment

"These pilot study findings showed that opiate-dependent injecting drug users with long injecting careers (most started between 1970 and 1982) and for whom opiate treatment had failed multiple times previously were attracted into and retained by therapy with injectable opiates."

Metrebian, Nicky, Shanahan, William, Wells, Brian, and Stimson, Gerry, "Feasibility of prescribing injectable heroin and methadone to opiate-dependent drug users; associated health gains and harm reductions," The Medical Journal of Australia (MJA 1998; 168: 596-600).
https://www.mja.com.au/journal...

23. Crime Reduction

"Overall, results indicate that heroin prescription is a very promising approach in reducing any type of drug related crime across all relevant groups analyzed. It affects property crime as well as drug dealing and even use/possession of drugs other than heroin. These results suggest that heroin maintenance does not only have an impact by reducing the acquisitive pressure of treated patients, but also seems to have a broader effect on their entire life-style by stabilizing their daily routine through the commitment to attend the prescription center twice or three times a day, by giving them the opportunity for psychosocial support, and by keeping them away from open drug scenes."

Ribeaud, Denis, "Long-term Impacts of the Swiss Heroin Prescription Trials on Crime of Treated Heroin Users," Journal of Drug Issues (Talahassee, FL: University of Florida, Winter 2004), p. 188.
http://jod.sagepub.com/content...

24. Heroin Assisted Treatment vs Methadone Maintenance

"The German model project for heroin-assisted treatment of opioid dependent patients is so far the largest randomised control group study that investigated the effects of heroin treatment. This fact alone lends particular importance to the results in the (meanwhile worldwide) discussion of effects and benefits of heroin treatment. For the group of so-called most severely dependent patients, heroin treatment proves to be superior to the goals of methadone maintenance based on pharmacological maintenance treatment. This result should not be left without consequences. In accordance with the research results from other countries, it has to be investigated to what extent heroin-assisted treatment can be integrated into the regular treatment offers for severely ill i.v. opioid addicts."

Naber, Dieter, and Haasen, Christian, Centre for Interdisciplinary Addiction Research of Hamburg University, "The German Model Project for Heroin Assisted Treatment of Opioid Dependent Patients -- A Multi-Centre, Randomised, Controlled Treatment Study: Clinical Study Report of the First Study Phase," January 2006, p. 122.
http://www.heroinstudie.de/H-R...

25. Heroin Assisted Treatment in Switzerland

"Based on its 1992 call for proposals, the Federal Office of Public Health authorized HAT trials in Zürich, Bern, Basel, and Geneva involving about 1,000 persons in the first instance (Bammer et al. 2003). Studies of HAT continued in Switzerland beyond the first trials. The full results of this work are beyond the scope of this paper, but what may be hundreds of peer-reviewed journal articles on the trials, as well as a book produced by FOPH (Rihs-Middel et al. 2005), attest to the care taken to document a wide range of health and social outcomes from the HAT experience. In brief, some of these results are as follows (See esp. Uchtenhagen 2009, 34 and Bammer et al. 2003, 365):

"• It was possible to stabilize dosages of heroin, usually in two or three months, without a continuing increase of dosages, which some had feared.
"• There was significant and measurable improvement in health outcomes for patients, including significantly reduced consumption of illicit heroin and even illicit cocaine.
"• There was a significant reduction in criminal acts among the patients, to the point where the estimated benefits of this effect well exceeded the cost of the treatment (See also Killias et al. 2005).
"• Heroin from the trials did not find its way into illicit markets.
"• Initiation of new heroin use did not increase.
"• Utilization of treatments other than HAT, especially methadone, increased after the advent of HAT rather than declining as some had feared.
In short, the fears of opponents of HAT were largely refuted by solid evidence, though, of course, political debate would continue."

Csete, Joanne, "From the Mountaintops: What the World Can Learn from Drug Policy Change in Switzerland," Global Drug Policy Program (New York, NY: Open Society Foundations, May 2010), p. 19.
https://www.opensocietyfoundat...
https://www.opensocietyfoundat...

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