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… 

Supervised Injectable Opioid Treatment for the Management of Opioid Dependence

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.

Methadone Treatment of Opiate Addiction: A Systematic Review of Comparative Studies.

The authors conclude that methadone should still be considered the preferred treatment mode in comparison to slow-release oral morphine and heroin.

Staff concerns in heroin-assisted treatment centres.

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.

The virtual disappearance of injectable opioids for heroin addiction under the ‘British System’

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.

Beyond the Right to Injectable Heroin

In order to justify a right to HAT that is publicly funded, there needs to be evidence that HAT is safe and effective in randomized controlled trials (RCTs) and that it is costeffective when compared to other forms of opioid substitution treatment (OST), such as oral methadone or sublingual buprenorphine.

Feasibility of Double-Blind Clinical Trials with Oral Diacetylmorphine: A Randomized Controlled Phase II Study in an Inpatient Setting

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.

Free Will From the Neurophilosophical Perspective

A complete analysis of the ethical acceptability of HAT needs to go beyond the right of individuals to access it, to consider the impact that its provision may have on access to effective treatment for the majority of opioid-dependent individuals.

References

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The current status of heroin prescription treatment for heroin dependence

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  • Medicine
    Expert opinion on drug safety
  • 2005
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.

Heroin maintenance for chronic heroin dependents.

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.

Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials

Supervised coprescription of heroin is feasible, more effective, and probably as safe as methadone alone in reducing the many physical, mental, and social problems of treatment resistant heroin addicts.

Heroin-assisted treatment for opioid dependence: randomised controlled trial.

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.

Methadone Maintenance Treatment and other Opioid Replacement Therapies

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.

Evaluation of heroin maintenance in controlled trial.

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.

Provision of Diamorphine (Heroin) by Prescription for Drug Dependency

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.
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