Heroin-assisted treatment

Heroin assisted treatment, or diamorphine assisted treatment, refers to the prescribing of synthetic, injectable heroin to opiate addicts who do not benefit from or cannot tolerate treatment with one of the established drugs used in opiate replacement therapy like methadone or buprenorphine (brand name Suboxone). For this group of patients, heroin assisted treatment has proven superior in improving their social and health situation. It has also been shown to save money, as it significantly reduces costs incurred by trials, incarceration, health interventions and . It has also drastically reduced overdose deaths in the countries utilizing it, as patients take their dose in a controlled, professionally supervised setting, and Narcan (naloxone) is on hand in the case of an accidental overdose. Opiate related overdoses in the U.S. kill around 20,000 people per year.

Heroin assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands and Denmark. Additional trials are being carried out in Canada and Belgium.

The British have had system of heroin maintenance since the 1920s. For decades it supplied a few hundred addicts nationwide, most of whom were doctors themselves. It was de-emphasized considerably during the 1960s-1980s as a result of the U.S. led "war on drugs". Because of the lack of large-scale trials, only anecdotal evidence existed as to the efficacy of the treatment. This changed in 1994 when Switzerland, faced with one of the largest open drug scenes in Europe at the time, started large-scale trials on the potential use of diamorphine as a maintenance drug. They proved diamorphine to be a viable maintenance drug which has shown equal or better rates of success than methadone in terms of assisting long-term users establish stable, crime-free lives. These results encouraged countries like Germany and the Netherlands to conduct their own trials and finally to include heroin assisted treatment fully as a part of the national health system in 2009. In recent years the British have begun moving towards the inclusion of heroin maintenance programs as a legitimate component of their National Health Service. In 2013 European Union's European Monitoring Centre for Drugs and Drug Addiction issued guidelines for the years 2013-2020; for the first time since the EMCDDA's 1995 inception, the group advocated "reducing the health and social risks and harms caused by drugs" in addition to longstanding policies of lessening demand and supply. Both the United Nations Office on Drugs and Crime and the Transnational Institute have released documents advocating harm-reduction strategies, though only the latter mentions heroin-assisted therapy. It should be noted that "harm reduction" remains a nebulous term which can include a wide variety of treatment modalities, many of which do not include heroin-assisted therapy.

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