Feasibility of prescribing injectable heroin and methadone to opiate‐dependent drug users: associated health gains and harm reductions

@article{Metrebian1998FeasibilityOP,
  title={Feasibility of prescribing injectable heroin and methadone to opiate‐dependent drug users: associated health gains and harm reductions},
  author={Nicky Metrebian and Gerry V. Stimson and William Shanahan and Brian Wells},
  journal={Medical Journal of Australia},
  year={1998},
  volume={168}
}
To assess the feasibility of offering the choice of prescribing injectable heroin (diamorphine) or injectable methadone to opiate‐dependent injecting drug users and to assess whether there are health and social gains associated with prescribing injectable opiates. 
The injection of methadone syrup in New South Wales: patterns of use and increased harm after partial banning of injecting equipment
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Methadone injectors and the risk practices associated with injecting methadone in New South Wales, Australia are described to assess the impact on injecting drug use and risk behaviour of the withdrawal from government‐funded needle and syringe programs.
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An overview of developments and plans for heroin-assisted treatment studies in a total of NINE countries and a comparison of clients receiving heroin with those receiving injectable methadone at a West London drug clinic are offered.
Drug Users' Experiences of Prescribed Injectable Methadone: The Impact on Drug Use and Perceptions of Stability
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Although a number of the respondents reported sufficient stability to contemplate employment and relationships, few spoke about abstinence as a viable goal in the short-term and many participants reported considerable ambivalence about the experience of receiving injectable methadone prescriptions.
Heroin Prescribing in the UK: Lost Opportunities for Research
TLDR
Oral methadone is considered the best form of maintenance substitution drug due to its ease of administration, duration of action, and safety and efficacy, but there are some opiate dependent drug users who appear unsuited to it.
Prescribing drug of choice to opiate dependent drug users: a comparison of clients receiving heroin with those receiving injectable methadone at a West London drug clinic
TLDR
Fifty-eight long-term treatment resistant opiate-dependent drug users were offered the choice of receiving injectable heroin or injectable methadone at a West London drug clinic, and one-third chose injectable Methadone.
Heroin maintenance for chronic heroin-dependent individuals.
TLDR
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.
Heroin-assisted treatment as a response to the public health problem of opiate dependence.
TLDR
An overview of the prevalence of injection drug use and the opiate dependence problem internationally, the current opiated dependence treatment landscape in several countries, and the status of ongoing or planned heroin-assisted treatment trials in Australia, Canada and certain European countries is provided.
Heroin maintenance for chronic heroin dependents.
TLDR
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.
Heroin and methadone substitution treatments : harm reduction and the effectiveness of 'flexible' prescribing for the treatment of opioid dependency
TLDR
It was concluded that the available empirical evidence regarding heroin prescribing is limited, and although some clinicians are yet to be convinced, it seems heroin does have its merits as a viable treatment option.
Diamorphine treatment for opiate dependence: putative markers of concomitant heroin misuse
TLDR
Findings show that the detection of urinary noscapine and papaverine metabolites is useful in distinguishing between use of pharmaceutical diamorphine and street heroin.
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References

SHOWING 1-10 OF 30 REFERENCES
'Horse trading': prescribing injectable opiates to opiate addicts. A descriptive study.
TLDR
The clinical audit of 40 opiate-dependent individuals who were prescribed injectable drugs (heroin or methadone) between June 1987 and June 1989 is described to attract entrenched injectors into contact with treatment services and to promote movement away from injecting drug use and reduce HIV risk behaviour.
The Swiss heroin trials: testing alternative approaches
TLDR
Results of the evaluation of heroin and other injectable opiate prescribing in Switzerland show that it was feasible to provide heroin by intravenous injection at a clinic, up to three times a day, for seven days a week, while maintaining good drug control, good order, client safety, and staff morale.
Prescribing drug of choice to illicit heroin users: the experience of a U.K. community drug team.
Evaluation of heroin maintenance in controlled trial.
TLDR
Heroin can be seen as maintaining the status quo, with the majority continuing to inject heroin regularly and to supplement their maintenance prescription from other sources; it was associated with a continuing intermediate level of involvement with the drug subculture and criminal activity.
Prescribing injectable and oral methadone to opiate addicts: results from the 1995 national postal survey of community pharmacies in England and Wales
TLDR
The distinctively British practice of prescribing injectable methadone was found to be widespread and, contrary to guidance, to be as prevalent in non-specialist as specialist settings.
Fortnightly Review: Methadone maintenance treatment in opiate dependence: a review
This paper examines the changes and advances in research and clinical practice and examines the role of treatment structure and programme characteristics in the delivery of methadone maintenance.
Reliability and validity of the Opiate Treatment Index among a sample of opioid users in the United Kingdom.
TLDR
To validate the Opiate Treatment Index for use in the United Kingdom, 72 subjects attending two methadone clinics in London completed confidential interviews with two researchers at two points in time, 1-2 weeks apart, to suggest a high cross-cultural validity for the OTI.
Heroin addiction and drug policy: the British system.
TLDR
An overview of British drug policy set in the context of international activities, with contributions from key figures in the field, covering both historical and contemporary aspects of the evolving "British System".
Treatment of heroin users
TLDR
In distancing ourselves from the suggestion that the authors are “pandering to American prohibitionist fundamentalism”, they do not wish to be forced to embrace a similarly extreme opposite position of providing insufficiently controlled supplies of the “drug of choice” or “state-rationed drugs”.
Should the controlled provision of heroin be a treatment option? Australian feasibility considerations.
TLDR
A Stage 1 examination found that a trial of controlled provision of heroin is feasible in principle and recommended a further stage (Stage 2) of feasibility investigations to explore the practicalities.
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