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  • EMCDDA report presents latest evidence on heroin-assisted treatment for hard-to-treat opioid users

    Posted on April 19th, 2012 TimB No comments

    The prescription of substitution drugs, together with appropriate psychosocial support, is an integral part of today’s mainstream approach to treating heroin dependence. This has come about because over the last two decades, an increasing body of high-quality research has demonstrated the efficacy of using drugs such as methadone and buprenorphine to help stabilise and improve the health status of those dependent on illicit ‘street’ heroin. The weight of evidence has been sufficient to counterbalance legitimate concerns about the value of replacing one opioid drug with another. Most importantly, the development of good clinical practice and safeguards has ensured that any possible unintended negative consequences have been largely avoided. This is important for the prescription of medicines that themselves have considerable abuse potential.

    Today, methadone and buprenorphine are among the first-line responses to the treatment of opioid dependence. However, as with other pharmacologically-based treatments across the medical spectrum, some patients are poor responders. A small, but important, minority of chronic heroin-dependent individuals repeatedly fail to benefit from this kind of intervention. This group may be a small one, but it is also one in which the negative health and social implications of long-term drug dependence are pronounced. The effective treatment of these individuals thus has a high relative potential to impact on the health costs associated with drug dependence and this is the underlying theme that this Insights publication addresses.

    History has taught us that the introduction of effective interventions in the drugs field can sometimes, at first, seem counter-intuitive and be viewed as controversial. This is true of the subject of this publication and this is also the reason why the clear-headed evaluation of evidence is so important. Internationally, a number of experimental projects using robust research designs have been beginning to suggest that for some of those failing to respond to other approaches, the use of diamorphine as a substitution medicine may be an effective way forward. This is not simply a case of giving heroin to heroin addicts. Rather, studies have looked at the use of heroin as part of a highly regulated treatment regime, targeting a particularly difficult-to-treat group of patients.

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