Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: a follow-up study

  title={Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: a follow-up study},
  author={J{\"u}rgen Rehm and Patrick Gschwend and T. Steffen and F{\'e}lix Gutzwiller and Anja Dobler-Mikola and Ambros A Uchtenhagen},
  journal={The Lancet},
BACKGROUND Heroin-assisted substitution treatment for severely opioid-dependent drug users has been available in Switzerland since 1994. Our aim was to ascertain the feasibility, safety, and efficacy of this treatment. METHODS We did a cohort study in 21 community outpatient treatment centres. We assessed 1969 opioid-dependent drug users, who began heroin-assisted substitution treatment between January, 1994, and December, 2000, to ascertain admission and discharge patterns, and patient… Expand
Heroin maintenance treatment for chronic heroin-dependent individuals: a Cochrane systematic review of effectiveness.
A Cochrane systematic review of all relevant randomized controlled trials found that heroin prescription effectiveness is questionable; those in treatment use less street heroin and are likely to have less criminal activities; it is unclear if heroin attracts people in treatment. Expand
Comparative study of the effectiveness of slow-release morphine and methadone for opioid maintenance therapy.
Oral slow-release morphine is as effective as methadone in the treatment of opioid dependency, with comparable safety and tolerability and a greater benefit on patient wellbeing. Expand
A prospective cohort study on orally administered heroin substitution for severely addicted opioid users.
DAM tablets seem to be an effective and safe application mode of heroin-assisted substitution treatment of severely addicted opioid users and Randomized clinical trials to compare its relative efficacy to other substances are necessary. Expand
Heroin maintenance for chronic heroin-dependent individuals.
The available evidence suggests an added value of heroin prescribed alongside flexible doses of methadone for long-term, treatment refractory, opioid users, to reach a decrease in the use of illicit substances, involvement in criminal activity and incarceration, a possible reduction in mortaliity; and an increase in retention in treatment. Expand
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HAT is associated with improvements in mental and physical health in the long term and illicit drug use as well as health and social stabilization is described. Expand
Effectiveness of diacetylmorphine versus methadone for the treatment of opioid dependence in women.
Among long-term opioid dependent women who have not benefited sufficiently from available treatments, medically prescribed diacetylmorphine is more effective than oral methadone. Expand
Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlands.
Four years of long-term HAT is an effective treatment for chronic heroin addicts who have failed to benefit from methadone maintenance treatment and is associated with stable physical, mental and social health and with absence of illicit heroin use and substantial reductions in cocaine use. Expand
Heroin maintenance for chronic heroin dependents.
Assessment of the efficacy and acceptability of heroin maintenance versus methadone or other substitution treatments for opioid dependence, in retaining patients in treatment; reducing the use of illicit substances and improving health and social functioning and no definitive conclusions are possible. Expand
Controlled trial of prescribed heroin in the treatment of opioid addiction.
These findings support the hypothesis that, under the same conditions, DAM could be safely delivered, in the context and imply that this treatment could provide an effective alternative for the treatment of socially excluded, opioid-dependent patients with severe physical and mental health problems because of drug addiction. Expand
Intravenous opiate maintenance in a cohort of injecting drug addicts.
Retention is high in the intravenous opiate maintenance program and favours the continuation of this drug policy, and individuals with a shorter history of injecting drug use and of older age are more likely to continue intravenous Opiate maintenance treatment. Expand


Medical Co-Prescription of Heroin to Chronic, Treatment-Resistant Methadone Patients in the Netherlands
The paper provides a detailed description of the randomized clinical trial regarding the effectiveness of co-prescribed heroin that is now underway in the Netherlands and a brief discussion of the likely consequences for future treatment options of different study outcomes. Expand
[Development of skin diseases in intravenous drug dependent patients treated with heroin substitution].
It is shown that skin diseases are a frequent and important complication among intravenous drug addicts and heroin-supported treatment led to favourable progress of the dermatological situation among patients. Expand
During treatment, a significant reduction in risk-taking behavior was observed in a target population of heroin-dependent persons who failed in previous treatments, and this confirms that a group of drug dependence with severe medical problems was reached in accordance with the admission criteria for the studies. Expand
The Case for a Heroin Substitution Treatment Trial in Canada
  • B. Fischer, J. Rehm
  • Medicine
  • Canadian journal of public health = Revue canadienne de sante publique
  • 1997
This paper argues for the establishment of a heroin substitution trial in Canada, with the goal of investigating the potential of heroin substitution to significantly reduce the health and social costs to Canadians from illicit opiate use. Expand
Prescriptions of Narcotics for Heroin Addicts: Main Results of the Swiss National Cohort Study
A review of a programme studying the prescription of narcotics for heroin addicts. Issues addressed include toxicology side effects, characteristics of patients, changes in criminal behaviour, andExpand
Cost-benefit analysis of heroin maintenance treatment.
Introduction: cost analysis on the medical prescription of narcotics definition of the problem, scope of the study, procedure, types of costs, validation of the results results, including project comparisons. Expand
The Heroin Prescribing Debate: Integrating Science and Politics
The debate about the merits of heroin treatment could be substantially informed by clinical trials that meet rigorous scientific standards, and a series of interlocking trials with various designs and control groups are essential, and social impacts must also be monitored. Expand
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In the last 10 years, many countries have seen a rapid expansion in their specific drug treatment services. This book describes the ways in which 20 different countries worldwide have chosen to copeExpand
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The history of illicit drug issues in Switzerland is outlined, and some selected factors that promote or impede changes in drug treatment systems, such as treatment policy and the public response to treatment measures are considered. Expand
Heroingestützte Therapie für Opiatabhängige - weder Allheilmittel noch Teufelswerk
Ethische, wissenschaftliche und praktische Probleme bei der Behandlung von Opiatabhangigen unter Einsatz von Heroin als Substitutionsmittel werden erortert. Diese Probleme ergeben sich zum einen ausExpand