Benefits of heroin treatment for drug users

Drug users who do not benefit from conventional treatments for heroin addiction should be able to access the drug through the health system, urges a Canadian expert in The BMJ today.

Standard treatments for heroin drug addiction include detoxification, abstinence programmes and methadone maintenance, but there is a subgroup of patients for whom these do not work.

As doctors can provide no effective treatments for these patients, many will remain "outside the healthcare system" and there is "overwhelming" evidence that they will relapse into using illicit heroin and "suffer immeasurably" while costing society a "fortune," explains Martin T Schechter, Professor, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.

Illicit heroin is a dangerous street drug because its dose and purity are unknown and users face the risk of overdose and death. Because the drug is illegal, many users engage in unsafe practices, for example, using contaminated syringes that increase the risk of life threatening infections such as HIV and hepatitis, and its use often leads to crime and sex work.

Many users are often in and out of hospitals and prisons for these reasons, he explains, adding that they can be "deeply affected by the illness of the addiction and its consequences."

But heroin assisted treatments should be offered to this vulnerable group of patients, he argues, because they have been shown to improve outcomes, reduce harm, lower societal cost and make savings for the healthcare system.

Heroin is a highly addictive, illegal drug. It is used by millions of addicts around the world who are unable to overcome the urge to continue taking this drug every day of their lives - knowing that if they stop, they will face the horror of withdrawal.

Heroin (like opium and morphine) is made from the resin of poppy plants. Milky, sap-like opium is first removed from the pod of the poppy flower. This opium is refined to make morphine, then further refined into different forms of heroin.

Most heroin is injected, creating additional risks for the user, who faces the danger of AIDS or other infection on top of the pain of addiction.

Currently, this type of treatment is not offered following regulations put in place by the Canadian government in 2014 although a small group of participants are being given the drug after benefiting from it in a successful clinical trial.

Schechter notes six randomised controlled trials that found heroin assisted treatment to be more effective than standard treatments for such patients, and the recent Cochrane Collaboration review that concluded that it can help to decrease illicit substance use, criminal activity, incarceration and possibly reduce mortality and increase compliance with treatment.