Prescription of Heroin for the Management of Heroin Dependence

@article{Lintzeris2009PrescriptionOH,
  title={Prescription of Heroin for the Management of Heroin Dependence},
  author={Nicholas Lintzeris},
  journal={CNS Drugs},
  year={2009},
  volume={23},
  pages={463-476}
}
The prescription of heroin (diamorphine) for the management of heroin dependence is a controversial treatment approach that was limited to Britain until the 1990s. Since then a number of countries have embarked upon clinical trials of this approach, and it is currently licensed and available in several European countries. To date, six randomized controlled trials (RCTs) with over 1600 patients and several cohort studies have examined injected (or inhaled) heroin treatment. This article reviews… Expand
Supervised Injectable Opioid Treatment for the Management of Opioid Dependence
TLDR
Critical, unresolved issues concerning this modality of treatment relate to the way in which it is approached—either as a medium-term, intensive intervention where other treatment has failed, designed to bring people into conventional opioid agonist treatment (OAT); or an indefinite support aimed at reducing social and personal harm. Expand
Methadone Treatment of Opiate Addiction: A Systematic Review of Comparative Studies.
TLDR
The authors conclude that methadone should still be considered the preferred treatment mode in comparison to slow-release oral morphine and heroin. Expand
Staff concerns in heroin-assisted treatment centres.
TLDR
Seven HAT treatment centres in four countries were visited in order to observe diacetylmorphine (DAM) administration and to study the main concerns of the staff. Expand
The virtual disappearance of injectable opioids for heroin addiction under the ‘British System’
TLDR
Injectable opioid maintenance treatment for heroin dependence under the unsupervised ‘British System’ is disappearing, although not extinct, if injectable opioids are prescribed, however, many prescriptions are less than daily instalments. Expand
Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial
TLDR
Treatment with supervised injected heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methad one, and UK Government proposals should be rolled out to support the positive response that can be achieved with heroin maintenance treatment for previously unresponsive chronic heroin addicts. Expand
Beyond the Right to Injectable Heroin
Buchman and colleagues (2010) appeal to a respect for persons to justify the provision of heroin-assisted treatment (HAT) for persons dependent upon heroin. They argue that heroin-dependent persons,Expand
Commentary on Blanken et al. (2010): long-term heroin-assisted treatment-some more questions and answers.
TLDR
It is highlighted that many HAT patients are ‘trapped’ within the rigidity of the treatment model—attending a specific clinic on average twice a day, 28 days a month for their heroin dose, while stable methadone patients progress to regular take-away doses and increased flexibility over time. Expand
Learning from the past, looking to the future - Is there a place for injectable opioid treatment among Australia's responses to opioid misuse?
TLDR
It is argued that with the aging populations of opioid-dependent people who have not benefited from existing treatment options, increased misuse of prescription opioids, rising overdose rates, and the risk of unfolding overdose crisis, it seems timely to pilot SIOT here. Expand
Feasibility of Double-Blind Clinical Trials with Oral Diacetylmorphine: A Randomized Controlled Phase II Study in an Inpatient Setting
TLDR
The feasibility of double-blind clinical trials using b.i.d. immediate-release oral DAM is shown allowing further phase III clinical trials in the process of introducing oral DAM as a medication for heroin-dependent patients not responding to standard maintenance treatments. Expand
Optimizing heroin-assisted treatment (HAT): assessment of the contribution of direct ethanol metabolites in identifying hazardous and harmful alcohol use.
TLDR
Improved detection of hazardous or harmful alcohol consumption in the context of HCV and heroin dependence will allow for earlier intervention in this population of patients in HAT and suggest the complementary use of both. Expand
...
1
2
3
...

References

SHOWING 1-10 OF 71 REFERENCES
The current status of heroin prescription treatment for heroin dependence
  • A. Wodak
  • Medicine
  • Expert opinion on drug safety
  • 2005
TLDR
On present evidence, HP is feasible and safe with limited, but increasing, evidence of efficacy and effectiveness and although HP is more expensive than methadone, there is some evidence of cost effectiveness. Expand
Heroin maintenance for chronic heroin dependents.
TLDR
The present review focuses on the prescription of heroin to heroin dependents to assess 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. Expand
Heroin-assisted treatment for opioid dependence: randomised controlled trial.
TLDR
Heroin-assisted treatment is more effective for people with opioid dependence who continue intravenous heroin while on methadone maintenance or who are not enrolled in treatment, and should be considered for treatment resistance under medical supervision. Expand
Development of pharmaceutical heroin preparations for medical co-prescription to opioid dependent patients.
TLDR
The physicochemical and pharmaceutical properties of diacetylmorphine and the clinically investigated routes of administration, as well as routes of Administration utilised on the street in the context of developing pharmaceutical heroin formulations for prescription to addicts are reviewed. Expand
New aspects in the treatment of heroin dependence with special reference to neurobiological aspects
TLDR
Heroin prescription may be helpful for some of those who continue to regularly use illicit heroin while maintained on methadone or who refuse other available treatment options, but research-based evidence suggests that the intravenous (IV) application of heroin under medical supervision may have untoward side effects. Expand
Methadone Maintenance Treatment and other Opioid Replacement Therapies
TLDR
A comprehensive guide to the use of drug substitution in the treatment of opiate dependence, this handbook provides an up-to-date account of treatment research and practice in this growing area. Expand
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. Expand
Safety of injectable opioid maintenance treatment for heroin dependence
TLDR
Opioid doses commonly prescribed in IV opioid treatment induce marked respiratory and circulatory depression, as well as occasionally irregular paroxysmal EEG activity, which raises questions about the appropriateness of IV opioids treatment in the present form. Expand
Provision of Diamorphine (Heroin) by Prescription for Drug Dependency
TLDR
The evidence strongly suggests that diamorphine treatment may be of some value and that further trials are warranted, Nevertheless, there are a range of risks associated with diamorphines trials and these are also discussed. Expand
Long-term effects of heroin-assisted treatment in Germany.
TLDR
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
...
1
2
3
4
5
...