"A few key conclusions and discussion points regarding the state and future of HAT (heroin-assisted treatment) can be offered based on the above review of completed or ongoing studies.
Methadone Maintenance as a Treatment for Opioid Dependence: "Methadone is a long-acting µ-opioid receptor agonist, introduced in the 1960s, after being developed in Germany at the end of World War II.60 It has an onset of action within 30 minutes61-63 and an average duration of action of 24 to 36 hours. Its oral bioavailability is excellent and approaches 90%.
"Naloxone distribution programs in the US are ongoing in Chicago, Baltimore, San Francisco, New Mexico and New York City. Additional community-based organizations interested in minimizing the adverse consequences of drug use in several cities in the US, including Los Angeles, Providence, Pittsburgh and Boston, are in the process of planning and developing naloxone administration programs for drug users."
"Heroin prescription is a form of medical care that involves strictly regulated and controlled prescription of heroin. Offered on its own or as a complement to treatment programs, it is often targeted for use by people for whom opioid substitution treatment and other programs have not succeeded."
"Findings show such programs are feasible and are associated with a number of positive outcomes,12 including:
Global Heroin Treatment Need and Overdose Deaths: "More than 60 per cent of drug treatment demand in Asia and Europe relate to opiates that are, especially heroin, the most deadly drugs. Deaths due to overdose are, in any single year, as high as 5,000-8,000 in Europe, and several times this amount in the Russian Federation alone."
"Total global opium production jumped by 65 per cent from 2016 to 2017, to 10,500 tons, easily the highest estimate recorded by UNODC since it started estimating global opium production at the beginning of the twenty-first century.
Possible federal sentences for heroin possession include:
Amount: 1 kilogram or more of a mixture or substance containing a detectable amount of heroin.
Sentence: Not less than 10 years or more than life. No person sentenced under this subparagraph shall be eligible for parole during the term of imprisonment.
Amount: 100 grams or more of a mixture or substance containing a detectable amount of heroin.
North American Opiate Medication Initiative (NAOMI): "The North American Opiate Medication Initiative (NAOMI) is a carefully controlled (clinical trial) that will test whether medically prescribed heroin can successfully attract and retain street-heroin users who have not benefited from previous repeated attempts at methadone maintenance and abstinence programs.
"The NAOMI study will enroll 470 participants at three sites in Vancouver, Montreal and Toronto. The Toronto and Montreal sites are expected to begin recruitment this spring.
"Generally speaking, it is reasonable to conclude, on the basis of the available knowledge, that to a large extent DCFs [Drug Consumption Facilities] achieve the objectives set for them, and that the criticisms made of them are rarely justified. In fact, DCFs help to:
" reduce risk behaviour likely to lead to the transmission of infectious diseases, particularly HIV/AIDS, among the population of the worst affected drug users;
" reduce the incidence of fatal overdoses and, therefore, the mortality rate in this population;
"The total quantity of heroin seized globally reached a record high in 2016, while the quantities of opium and morphine seized reached the second highest level ever reported. The largest quantities of opiates seized were of opium (658 tons), followed by seizures of heroin (91 tons) and morphine (65 tons). Overall seizures of opiates, expressed in heroin equivalents, increased by almost 50 per cent from 2015 to 2016, of which the quantity of heroin seized exceeded that of opium and morphine.