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Heroin Addiction and Related Clinical Problems: 2017, 19, N2 (pages: 17 - 24)

The Role and Function of Heroin-Assisted Treatment at the Treatment System Level

Uchtenhagen A.

Summary: Introduction: Prescribing opium, morphine and heroin to opiate addicts has a long history, as an approach to prevent negative consequences from excessive and uncontrolled use. It rarely reached the majority of this target population. During the 20th century, moral concerns mainly led to control measures and total prohibition (except for medicinal use and research). Other opioid agonists replaced opiates for maintenance therapy; Methadone and Buprenorphine maintenance became the preferred approaches to reach out effectively heroin addicts and to allow for significant improvements in health and social status of patients. Their role for the treatment system is essential. Aim: to describe the revival, role and function of heroin-assisted treatment (HAT), and to review critical concerns against this approach in the light of research evidence. Methods: research reports, reviews and monographs on opiates, agonist maintenance treatment and HAT. Results: The extent of HAT in countries where it is available is modest, in comparison to other agonist maintenance treatments for opiate dependence. Within the European Union, the role of HAT is marginal. A range of therapeutic, safety, prevention and economic concerns about potential negative effects of HAT, for patients and for the treatment system, are discussed in the light of relevant research evidence. None of the concerns is justified. Positive effects for the treatment system and for public order prevail. Conclusions: the present model of HAT has good outcomes for previously treatment-resistent heroin addicts, is a safe and cost-effective therapy and a useful element in a comprehensive treatment system for heroin addicts.