Heroin assisted treatment

Heroin assisted treatment, or diamorphine assisted treatment, refers to the prescribing of synthetic, injectable heroin to opiate addicts that do not benefit from or cannot tolerate treatment with one of the established drugs used in opiate replacement therapy like methadone or buprenorphine. For this group of patients, heroin assisted treatment has proven superior in improving their social and health situation. It has also been shown to save money, despite its high costs, as it significantly reduces costs incurred by trials, incarceration, health interventions and delinquency.

Heroin assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands, Denmark and the United Kingdom. Additional trials are being carried out in Canada and Belgium.

History
The British have had a system of heroin maintenance since the 1920s. For decades it supplied a few hundred addicts nationwide, most of whom were doctors themselves. It was de-emphasized considerably during the 1960s-1980s as a result of the U.S. led "war on drugs". Because of the lack of large-scale trials, only anecdotal evidence existed as to the efficacy of the treatment. This changed in 1994 when Switzerland, against strong opposition from U.N. drug control authorities, started large-scale trials on the potential use of diamorphine as a maintenance drug. They proved diamorphine to be a viable maintenance drug which has shown equal or better rates of success than methadone in terms of assisting long-term users establish stable, crime-free lives. These results encouraged countries like Germany and the Netherlands to conduct their own trials and finally to include heroin assisted treatment fully as a part of the national health system. In recent years the British are also again moving toward heroin maintenance as a legitimate component of their National Health Service.

Modes of operation
While the British system trusts the patient with weekly prescriptions, other countries had to impose stronger restrictions to avoid deviation to the illegal market. Patients there have to appear twice a day at a treatment center where they inject their doses of diamorphine under the supervision of medical staff. To avoid withdrawal symptoms in between injections, most patients are given an additional daily dose of methadone.

In the Netherlands, both injectable Diamorphine HCl as injectable salt in dry ampoules as well as Heroin base with 5-10% caffeine for vaporisation are available, both are to be taken twice daily in a supervised setting and will be accompanied with a daily take home dosage of methadone for the evening.

In Switzerland patients may be allowed to appear only once a day and receive part of their diamorphine in pill form for oral consumption. This is possible only after a six-month period and is usually granted only if necessary to hold down a job.

Criticism
Critics, such as the Drug Free America Foundation, have criticised heroin assisted treatment along with other harm reduction strategies for allegedly creating the perception that certain behaviors can be partaken safely, such as illicit drug use, claiming that this may lead to an increase in that behavior by people who would otherwise be deterred.

However in Switzerland the incidence of heroin abuse has declined sharply since the introduction of heroin assisted treatment. As a study published in The Lancet concluded:

Also, the notion that patients in heroin assisted treatment are enabled to maintain "destructive behavior" contradicts the findings that patients significantly recover in terms of both their social and health situation. Many participants in the German "Heroinstudie" were able to find employment (~ 40%), some even started a family after years of homelessness and delinquency.