Advertisement

CNS Drugs

, Volume 11, Issue 4, pp 253–262 | Cite as

Provision of Diamorphine (Heroin) by Prescription for Drug Dependency

Issues and Recommendations
  • Gabriele BammerEmail author
Current Opinion

Abstract

Existing evidence for the efficacy of diamorphine treatment of heroin dependence is presented, focusing first on ‘gold standard’ randomised controlled trials and then on other forms of evidence. 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 diamorphine trials and these are also discussed. It is recommended that: (i) extensive trialling of the efficacy, safety and cost-effectiveness of diamorphine should be undertaken; (ii) trials should be conducted to the highest scientific standards, but the standards should be realistic; (iii) the risks associated with diamorphine prescribing must be taken seriously and included in trial planning and evaluation; (iv) competing moral positions about diamorphine prescribing should be spelt out and debated; and (v) diamorphine prescription should be viewed as only one of a number of treatment options and should be investigated as part of a pluralist approach to the treatment of heroin dependence.

Keywords

Adis International Limited Heroin Buprenorphine Naltrexone Methadone Maintenance Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Strang J, Gossop M, editors. Heroin addiction and drug policy: the British system. Oxford: Oxford University Press, 1994Google Scholar
  2. 2.
    Strang J. ‘The British system’: past, present and future. Int Rev Psychiatry 1989; 1: 109–20CrossRefGoogle Scholar
  3. 3.
    Stimson G. British drug policies in the 1980s: a preliminary analysis and suggestions for research. Br J Addict 1987; 82: 477–88PubMedCrossRefGoogle Scholar
  4. 4.
    Koran LM. Heroin maintenance for heroin addicts: issues and evidence. N Engl J Med 1973: 654-60Google Scholar
  5. 5.
    Lewis E Jr. A heroin maintenance program in the United States? JAMA 1973; 223: 539–46PubMedCrossRefGoogle Scholar
  6. 6.
    Trebach A. The heroin solution. New Haven, CT: Yale University Press, 1982Google Scholar
  7. 7.
    Bayer R. Heroin maintenance, the Vera proposal and narcotics reform: an analysis of the debate 1971–1973. Contemp Drug Problems 1975; 4: 297–321Google Scholar
  8. 8.
    Robinson CD. Aproposal for a heroin maintenance experiment in New York City: the limits of reform strategy. Contemp Crises 1978; 2: 1–26CrossRefGoogle Scholar
  9. 9.
    Strang J, Sheridan J. Heroin prescribing in the ‘British System’ of the mid 1990s: data from the 1995 national survey of community pharmacies in England and Wales. Drug Alcohol Rev 1997; 16: 7–16PubMedCrossRefGoogle Scholar
  10. 10.
    Ward J, Mattick RP, Hall W, editors. Methadone maintenance treatment and other opioid replacement therapies. Amsterdam: Harwood Academic, 1998Google Scholar
  11. 11.
    Gerstein DR, Johnson RA, Harwood HJ, et al. Evaluating recovery services: the California Drug and Alcohol Treatment Assessment (CALD ATA). General report submitted to the State of California Department of Alcohol and Drug Programs by National Opinion Research Centre at the University of Chicago and Lewin-VHI Inc., Fairfax, VA. Sacramento, CA: California Department of Alcohol and Drug Programs, 1994Google Scholar
  12. 12.
    National Institute on Drug Abuse. Drug abuse treatment: an economical approach to addressing the drug problem in America. Rockville, MD: US Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, 1991Google Scholar
  13. 13.
    Rydell CP, Everingham SS. Controlling cocaine: supply versus demand reduction. Santa Monica, CA: RAND Drug Policy Research Center, 1994Google Scholar
  14. 14.
    Uchtenhagen A, Gutzwiller F, Dobler-Mikola A, et al. Programme for a medical prescription of narcotics: a synthesis of results. Eur Addict Res 1997; 3: 160–3CrossRefGoogle Scholar
  15. 15.
    Central Committee on the Treatment of Heroin Addicts. Investigating the medical prescription of heroin: a randomized trial to evaluate the effectiveness of medically co-prescribed heroin and oral methadone, compared to oral methadone alone in chronic, treatment-refractory heroin addicts. Utrecht: Central Committee on the Treatment of Heroin Addicts, 1997Google Scholar
  16. 16.
    Bammer G. Report and recommendations of stage 2 feasibility research into the controlled availability of opioids. Canberra: National Centre for Epidemiology and Population Health, the Australian National University and the Australian Institute of Criminology, 1995. Report and working papers available from: http://www-nceph.anu.edu.au/pub/opioids/opioids.htm [accessed 1999 Feb 17]
  17. 17.
    Bammer G, Douglas RM. The ACT heroin trial proposal: an overview. Med J Aust 1996; 164: 690–2PubMedGoogle Scholar
  18. 18.
    Moore DL, Bernard S. Clinical trials in women’s health research. Part I: the drug discovery and development process. J Womens Health 1996; 5: 103–7CrossRefGoogle Scholar
  19. 19.
    Moore DL, Bernard S. Clinical trials in women’s health research. Part II: phase IV clinical research and beyond. J Womens Health 1996; 5: 303–9CrossRefGoogle Scholar
  20. 20.
    Bammer G. The ACT heroin trial: intellectual, practical and political challenges. The 1996 Leonard Ball Oration. Drug Alcohol Rev 1997; 16: 287–96PubMedCrossRefGoogle Scholar
  21. 21.
    Bammer G, Dobler-Mikola A, Fleming PM, et al. Prescribing heroin to dependent users — integrating science and politics. Science 1999. In pressGoogle Scholar
  22. 22.
    Bammer G. Should the controlled provision of heroin be a treatment option? Australian feasibility considerations. Addiction 1993; 88: 467–75PubMedCrossRefGoogle Scholar
  23. 23.
    Hartnoll RL, Mitcheson MC, Battersby A, et al. Evaluation of heroin maintenance in controlled trial. Arch Gen Psychiatry 1980; 37: 877–84PubMedCrossRefGoogle Scholar
  24. 24.
    Perneger TV, Giner F, del Rio M, et al. Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments. BMJ 1998; 317: 13–8PubMedCrossRefGoogle Scholar
  25. 25.
    Uchtenhagen A, Gutzwiller F, Dobler-Mikola A. Versuche fuer eine aerztliche Verschreibung von Betaeubungsmitteln. Abschlussbericht der Forschungsbeauftragten. Zurich: Institut fuer Suchtforchung in Verbindung mir der Universitaet Zuerich und Institut fuer Sozial- und Praeventivmedizin der Universitaet Zuerich, 1997. A monograph in English based on this report will be published in 1999: Uchtenhagen A, Gutzwiller F, Dobler-Mikola A, editors. Medical Prescription of Narcotics Research Programme. Final report of the principal investigators. Basel: KargerGoogle Scholar
  26. 26.
    Uchtenhagen A, Dobler-Mikola A, Gutzwiller F. Medically controlled prescription of narcotics: a Swiss national project. Int J Drug Policy 1996; 7: 31–6Google Scholar
  27. 27.
    Killias M, Uchtenhagen A. Does medical heroin prescription reduce delinquency among drug-addicts? On the evaluation of the Swiss heroin prescription projects and its methodology. Studies Crime Crime Prevention 1996; 5: 245–56Google Scholar
  28. 28.
    McCusker C, Davies M. Prescribing drug of choice to illicit heroin users: the experience of a U.K. community drug team. J Subst Abuse Treat 1996; 13: 521–31PubMedCrossRefGoogle Scholar
  29. 29.
    Metrebian N, Shanahan W, Wells B, et al. Feasibility of prescribing injectable heroin and methadone to opiate-dependent users: associated health gains and harm reductions. Med J Aust 1998; 168: 596–600PubMedGoogle Scholar
  30. 30.
    Stimson GV. Heroin and behaviour: diversity among addicts attending London clinics. Shannon: Irish University Press, 1973Google Scholar
  31. 31.
    Stimson GV, Oppenheimer E. Heroin addiction: treatment and control in Britain. London: Tavistock, 1982Google Scholar
  32. 32.
    Bammer G. Multidisciplinary policy research — an Australian experience. Prometheus 1997; 15: 27–39CrossRefGoogle Scholar
  33. 33.
    Ostini R, Bammer G, Dance P, et al. The ethics of experimental heroin maintenance. J Med Ethics 1993; 19: 175–82PubMedCrossRefGoogle Scholar
  34. 34.
    Rihs-Middel M. The Swiss Federal Office of Public Health’s research strategy and the prescription of narcotics. In: Lewis D, Gear C, Laeubli Loud M, et al., editors. The medical prescription of narcotics: scientific foundations and practical experiences. Seattle: Hogrefe and Huber, 1997: 4–11Google Scholar
  35. 35.
    Norberry J. Ethical issues. In: Feasibility research into the controlled availability of opioids. Vol 2. Canberra: National Centre for Epidemiology and Population Health, Australian National University, 1991: 177–86Google Scholar
  36. 36.
    Bammer G, Tunnicliff D, Chadwick-Masters J. How could an influx of users be prevented if Canberra introduces a trial of controlled availability of heroin? Feasibility research into the controlled availability of opioids. Stage 2, working papers number 9. Canberra: National Centre for Epidemiology and Population Health, Australian National University and the Australian Institute of Criminology, 1994Google Scholar
  37. 37.
    Dance P, Crawford D, Ostini R, et al. Is it time for a heroin maintenance program? Views of users and ex-users. Addict Res 1997; 5: 383–93CrossRefGoogle Scholar
  38. 38.
    Chesher GB. Understanding the opioid analgesics and their effects on skills performance. Alcohol Drugs Driving 1989; 5: 111–38Google Scholar
  39. 39.
    Finnegan LP, Kandall SR. Maternal and neonatal effects of alcohol and drugs. In: Lowinson JH, Ruiz P, Millman RB, editors. Substance abuse: a comprehensive textbook. 2nd ed. Baltimore: Williams and Wilkins, 1992: 628–56Google Scholar

Copyright information

© Adis International Limited 1999

Authors and Affiliations

  1. 1.National Centre for Epidemiology and Population HealthThe Australian National UniversityCanberraAustralia

Personalised recommendations