Skip to main content
SpringerLink
Log in

The Case for a Heroin Substitution Treatment Trial in Canada

  • Published:
Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

Illicit opiate use in Canada causes considerable harm and social cost. Methadone substitution treatment, which has been proven effective in reducing the negative effects associated with opiate use, has been used in Canada, but so far only on a small scale. Recent research suggests that, while expanding the availability of methadone substitution is certainly in the public health interest, it would not be sufficient in itself to reduce to a minimum the harms from illicit opiate use. On the basis of the epidemiology of opiate use and of related harms, and building on the experience of intervention efforts currently underway elsewhere, this paper argues for the establishment of a heroin substitution trial in Canada. Such a trial should have the goal of investigating the potential of heroin substitution to significantly reduce the health and social costs to Canadians from illicit opiate use.

Résumé

La consommation illégale d’opiacés au Canada est responsable de méfaits considérables et d’un lourd fardeau social. Le traitement de substitution à la méthadone a fait ses preuves quant à son efficacité à réduire les effets néfastes associés à l’usage d’opiacés. On y a recours au Canada, mais à petite échelle seulement. Des recherches menées récemment laissent supposer que bien qu’il serait dans l’intérêt de la santé publique de multiplier le nombre de programmes de traitement à la méthadone, cette mesure serait insuffisante en soi pour réduire au minimum les méfaits causés par l’usage illégal d’opiacés. Le présent article plaide pour qu’un essai de traitement de substitution de l’héroïne soit tenu au Canada. Il est fondé sur l’étude de l’épidémiologie de l’usage d’opiacés et de ses méfaits, et des interventions mises de l’avant à l’étranger. Un essai semblable aurait pour objectif d’investiguer le potentiel de la substitution de l’héroïne à réduire considérablement les fardeaux sociaux et de santé liés à l’usage illégal d’opiacés au Canada.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Information Canada. Commission of Inquiry into the Non-Medical Use of Drugs. Final Report. Ottawa, 1973.

    Google Scholar 

  2. Information Canada. Commission of Inquiry into the Non-Medical Use of Drugs. Ottawa, 1972.

    Google Scholar 

  3. Hser, YI. Prevalence estimation: Summary of common problems and practical solutions. J Drug Issues 1993a;23:335–43.

    Article  Google Scholar 

  4. Hser, YI. Prevalence estimation techniques for drug-using populations. Data sources: Problems and issues. J Drug Issues 1993b;23:217–28.

    Article  Google Scholar 

  5. Simeone RS, Nottingham WT, Holland L. Estimating the size of heroin-using population: An examination of the use of treatment admissions data. Int J Addictions 1993;28:107–28.

    Article  CAS  Google Scholar 

  6. Statistics Canada. Canada’s Alcohol and Other Drugs Survey. Ottawa: Health Canada, 1994.

    Google Scholar 

  7. Turner CF, Lessler JT, Gfroerer, JC. Survey Measurement of Drug Use: Methodological Studies. National Institute on Drug Abuse, U.S. Department of Health and Human Services, 1992.

    Google Scholar 

  8. Rehm J. Modes de consommation et répartition des drogues en Suisse. In: Fahrenkrug H, Rehm J, Müller R, et al (Eds.), Drogues illégales en Suisse 1990–1993. La situation dans les cantons et en Suisse. Zürich: Seismo, 1995;13–34.

    Google Scholar 

  9. Baden M. Narcotic abuse: A medical examiner’s view. In: Wecht CH (Ed.), Legal Medicine Annual. New York: Appleton Century-Crofts, 1971.

    Google Scholar 

  10. Single E, Robson L, Xie X, Rehm J in collaboration with Moore R, Choi B, Desjardins S, Anderson J. The Costs of Substance Abuse in Canada. Ottawa: Canadian Centre on Substance Abuse, 1996; ISBN:1-896323-18-9.

    Google Scholar 

  11. Rehm J, Ialomiteanu A, Walsh G, et al. The Quantification of Mortality Caused by Illicit Drugs in Canada, 1992. Toronto: Addiction Research Foundation, 1996.

    Google Scholar 

  12. Remis RS, Leclerc P, Routledge R, et al. Consortium to characterize injection drug users in Canada. Proposal to NHRDP, 1996.

    Google Scholar 

  13. Southtown Consulting. Heroin activity in metropolitan Toronto (study conducted for MTATSC), 1995.

    Google Scholar 

  14. Nadelmann E, McNeely J, Drucker E. Harm reduction drug control strategies: A global perspective. In: Lowinson J, Ruiz P, Millman R (Eds.), Substance Abuse: A Comprehensive Textbook. Baltimore: Williams and Wilkins, 1997.

    Google Scholar 

  15. Hankins C, Barlow K, Black S, et al. HIV, AIDS and Injection Drug Use. Ottawa: Health Canada, 1997.

    Google Scholar 

  16. Strathdee S, Patrick D, Currie S, et al. Needle exchange is not enough: Lessons from the Vancouver injecting drug use study. AIDS 1997;11:F59-F65.

  17. Department of Health and Human Services. Methadone maintenance treatment: Translating research into policy. Paper presented at American Methadone Treatment Association Conference National Institute on Drug Abuse International Forum, November 1995.

    Google Scholar 

  18. Xie X, Rehm J, Single E, Robson L. The Economic Costs of Alcohol, Tobacco and Illicit Drug Abuse in Ontario: 1992. Toronto: Addiction Research Foundation, 1996; ISBN:0-88868-274- 3; ARF Research Document Series, No. 127.

    Google Scholar 

  19. Bureau of Drug Surveillance. Data on methadone maintenance programs in Canada, unpublished. Ottawa: Health Canada, 1997.

    Google Scholar 

  20. Dole V, Nyswander M. The use of methadone for narcotic blockade. Br J Addiction 1968;63:55–57.

    Article  CAS  Google Scholar 

  21. Hubbard RI, Marsden, ME. Relapse to use of heroin, cocaine and other drugs in the first year after treatment. In: NIDA Research Monograph 72, U, Ed. Relapse and Recovery in Drug Abuse. Rockville, MD, 1986.

  22. Senay E, Uchtenhagen A. Methadone in the treatment of opioid dependence: A review of the world literature. In: Arif A, Westermeyer J (Eds.), Methadone Maintenance in the Management of Opioid Dependence. New York: Praeger, 1990.

    Google Scholar 

  23. Ball J, Ross A. The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services and Outcomes. New York: Springer- Verlag, 1991.

    Book  Google Scholar 

  24. Institute of Medicine. Federal Regulation of Methadone Treatment. Washington, DC: National Academy Press, 1995.

    Google Scholar 

  25. Nadelmann E, McNeely J. Doing methadone right. The Public Interest 1996;123, Spring.

  26. Giffen JP, Endicott S, Lambert S. Panic and indifference — The politics of Canada’s drug laws. Ottawa: Canadian Centre on Substance Abuse, 1991.

    Google Scholar 

  27. Halliday R. Management of the narcotic addict. BC Medical Journal 1963;5:412–14.

    Google Scholar 

  28. Non-Medical Use of Drugs Directorate. Trends in methadone use in the treatment of opiate dependence in Canada. Ottawa: Health and Welfare Canada, 1976.

    Google Scholar 

  29. Peachey JE, Franklin T. Methadone treatment of opiate dependence in Canada. Br J Addiction 1985;80:291–99.

    Article  CAS  Google Scholar 

  30. The College of Physicians and Surgeons in Ontario. Methadone maintenance guidelines, 1996.

    Google Scholar 

  31. International survey on the use of methadone in the treatment of narcotic addiction: Summary of results. Ottawa: Health Canada, 1996.

    Google Scholar 

  32. Swiss methadone report. Berne/Toronto: Swiss Federal Office of Public Health/Addiction Research Foundation, 1996.

    Google Scholar 

  33. Fischer B. Drug, communities and ‘harm reduction’ in Germany: The new relevance of ‘public health’ principles in local responses. J Public Health Pol 1995;16:389–411.

    Article  CAS  Google Scholar 

  34. Bossong H. Methadon-Substitutionsbehandlung. Das Grüene Gehirn-Der Arzt im Öffentlichen Gesundheitswesen. 36: Erg, 1995.

  35. Bossong H, Stöver H. Methadonbehandlung. Campus: Frankfurt, 1992.

    Google Scholar 

  36. Sells SB, Demaree RG, Hornick, CW. Comparative effectiveness of drug abuse treatment modalities. NIDA Services Research Administrative Report. Washington, DC, 1979.

    Google Scholar 

  37. Fischer B, Medved W, Rehm J, Gliksman L. Profile of illicit and un-treated opiate users in Toronto, Canada. Addiction Research under review.

  38. Hubbard RL, Marsden ME, Rachal JV, et al. Drug Abuse Treatment: A National Study of Effectiveness. Chapel Hill: University of North Carolina Press, 1989.

    Google Scholar 

  39. Simpson DD, Sells, SB. Effectiveness of treatment for drug abuse: An overview of the DARP research program. Advances in Alcohol and Substance Abuse 1982;2:7–29.

    Article  Google Scholar 

  40. Maddux JF, Vogtsberger KN, Desmond DP, Esquivel M. Program changes and retention on methadone. J Substance Abuse Treatment 1993;10:585–88.

    Article  CAS  Google Scholar 

  41. Kreek, MJ. Methadone in treatment: Physiological and pharmacological issues. In: DuPont RL, Goldstein A, O’Donnell J, Brown B (Eds.) Handbook on Drug Abuse. Rockville, MD: National Institute on Drug Abuse, 1979.

    Google Scholar 

  42. Kreek, MJ. Medical safety and side effects of methadone in tolerant individuals. J Psychoactive Drugs 1991;23:6.

    PubMed  Google Scholar 

  43. Jaffe JH, Martin, WR. Opioid analgesics and antagonists. In: Goodman Gilman A, Goodman L, Rall T, et al. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. New York: Pergamon Press, 1985;491–532.

    Google Scholar 

  44. Grund J-PC. Drug use as a social ritual: Functionality, symbolism and determinants of self-regulation. Rotterdam: IVO (Addiction Research Institute), 1993.

    Google Scholar 

  45. Uchtenhagen A, Gutzwiller F, Dobler-Mikola A. Versuche für eine ärztliche Verschreibung von Betäubungsmitteln. Institut für Suchtforschung in Verbindung mit der Universität Zürich, 1996.

    Google Scholar 

  46. Bammer G, Dance P, Stevens A, et al. Attitudes to a proposal for controlled availability of heroin in Australia: Is it time for a trial? Addiction Research 1996;4:45–55.

    Article  Google Scholar 

  47. Böllinger L. German drug laws in the context of international pressure and internal conflicts — A theoretical approach to the evolution of drug policy. Unpublished paper: University of Bremen, 1996.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Addiction Research Foundation, 33 Russell St., Toronto, ON, M5S 2S1, Canada

    Benedikt Fischer Dipl.Verw.wiss. & Jürgen Rehm PhD

  2. University of Toronto, Canada

    Benedikt Fischer Dipl.Verw.wiss. & Jürgen Rehm PhD

Authors
  1. Benedikt Fischer Dipl.Verw.wiss.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jürgen Rehm PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benedikt Fischer Dipl.Verw.wiss..

Additional information

The views expressed in this paper are those of the authors and do not necessarily reflect the views of the Addiction Research Foundation or the University of Toronto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fischer, B., Rehm, J. The Case for a Heroin Substitution Treatment Trial in Canada. Can J Public Health 88, 367–370 (1997). https://doi.org/10.1007/BF03403907

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03403907

Search

Navigation