Abstract
Few treatments are more controversial than the prescribing of injectable heroin (diamorphine) to heroin addicts. This practice is still banned in the USA and Australia, despite the serious drug problems in those countries. At present any UK doctor can prescribe injectable methadone for the treatment of heroin addiction; however, the prescribing of heroin requires a special licence from the Home Office. The National Treatment Agency for Substance Misuse is the statutory body currently responsible for advising purchasers (local drug action teams) in regard to specialist services for addictions. They have recently commissioned and published guidelines for the prescription of injectables in opiate addiction (National Treatment Agency for Substance Misuse, 2003). This follows the report of a Government committee, which stated:‘If diamorphine treatment could be offered to all problematic users who do not successfully access other treatments, we believe it could play a useful part in managing the social problems generated by this group of people’ (House of Commons Home Affairs Committee, 2003).
Highlights
Few treatments are more controversial than the prescribing of injectable heroin to heroin addicts
The National Treatment Agency recommends that injectable maintenance prescribing should only be undertaken in line with eight principles, summarised below (National Treatment Agency for Substance Misuse, 2003): (1) Treatment should involve a combination of drug and psychosocial treatments to form an integrated care package
The situation apparently changed in the summer of 2003 following publication of the findings of a Dutch trial. This randomised controlled trial of 549 participants with treatment-resistant heroin addiction provided good evidence to support the prescription of heroin; two-thirds of the participants were prescribed heroin to inhale rather than to inject
Summary
Few treatments are more controversial than the prescribing of injectable heroin (diamorphine) to heroin addicts. They have recently commissioned and published guidelines for the prescription of injectables in opiate addiction (National Treatment Agency for Substance Misuse, 2003) This follows the report of a Government committee, which stated:. The situation apparently changed in the summer of 2003 following publication of the findings of a Dutch trial (van den Brink et al, 2003) Overall, this randomised controlled trial of 549 participants with treatment-resistant heroin addiction provided good evidence to support the prescription of heroin; two-thirds of the participants were prescribed heroin to inhale rather than to inject. The National Treatment Agency for Substance Misuse expert committee reported that injectable maintenance treatment can cost 5-15 times as much as oral maintenance treatment programmes These estimates assumed that injectables are prescribed to take away. In part of my own service there is only one full-time member of staff allocated to provide alcohol services for a population of 250 000 people
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