"The heart of the challenge is the possibility that things could be different: overdose is a public health problem that can be solved. Unlike many of the other leading causes of death, death from opioid overdose is almost entirely preventable,21 and preventable at a low cost.22 Opioids kill by depressing respiration, a slow mode of death that leaves plenty of time for effective medical intervention.23 Overdose is rapidly reversed by the administration of a safe and inexpensive drug called naloxone.
"Heroin is particularly toxic because of high lipid solubility, which allows it to cross the blood–brain barrier within seconds and achieve high brain levels.10
"Naloxone is also lipid soluble and enters the brain rapidly. Reversal of respiratory depression is evident 3–4 minutes after IV and 5–6 minutes after subcutaneous administration.11"
"The NAOMI study provided injectable HDM to a small group of participants. An unexpected finding was that many participants couldn’t tell the difference between the effects of diacetylmorphine and HDM.
"However, the small number of participants receiving HDM did not permit researchers to draw any definite and scientifically valid conclusions as to the efficacy of HDM as a treatment option.
"Therefore, the SALOME investigators designed a study to test this hypothesis.
"The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) is a clinical study that tests alternative treatments for people with chronic heroin addiction who are not benefiting sufficiently from available treatments such as oral methadone.
"SALOME compared two medications – diacetylmorphine, the active ingredient of heroin, and hydromorphone (HDM), a legal, licensed pain medication.
Estimated Lifetime Prevalence of Substance Use in the US by Those Aged 12 and Older (Numbers in Thousands)
"The total area under opium poppy cultivation worldwide is estimated to have increased by some 37 per cent to almost 420,000 ha from 2016 to 2017, primarily reflecting an increase in the cultivation of opium poppy in Afghanistan. With 328,000 ha under opium poppy cultivation, Afghanistan accounted for more than three quarters of the estimated global area under illicit opium poppy cultivation in 2017, a record level.
"By far the highest prevalence of HIV among PWID [People Who Inject Drugs] is in South-West Asia and in Eastern and South-Eastern Europe, with rates that are, respectively, 2.4 and 1.9 times the global average. Together, those two subregions account for 49 per cent of the total number of PWID worldwide living with HIV. Although the prevalence of HIV among PWID in East and South-East Asia is below the global average, 24 per cent of the global total of PWID living with HIV reside in that subregion.
Prevalence of Heroin and Cocaine Use in Switzerland: "According to what is currently known, there are only a small number of dependent drug users who exclusively consume cocaine; most of those who are dependent on drugs consume heroin first and foremost. However, cocaine is increasingly consumed in addition to heroin.
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."