Heroin - Assisted Treatment (HAT)

Drug replacement and maintenance therapy have a long history of providing individuals struggling with problematic drug use with legal access to drugs that would otherwise be obtained through illegal means.

More than a half dozen countries in Europe and Canada have implemented heroin - assisted treatment (HAT) programs. Under HAT, pharmacological heroin is administered under strict controls in a clinical setting to those who have failed in other treatments like methadone.

Every published evaluation of HAT has shown extremely positive outcomes : major reductions in illicit drug use, crime, disease and overdose; and improvements in health, wellbeing, social reintegration and treatment retention. The U.S. should implement this innovative health - centered model.

HAT: A Successful Second - Line Treatment

Several countries have gone beyond methadone and adopted heroin - assisted treatment (HAT) programs, which have proven enormously successful and now operate in Switzerland, Netherlands, United Kingdom, Germany, Spain, Denmark, Belgium, Canada , and soon Luxembourg.

Also known as heroin maintenance, HAT allows for the provision of pharmacological grade heroin (diacetylmorphine) to select heroin - dependent people who have not previously responded to other forms of treatment.

Typically, patients receive injectable or inhalable heroin 2 - 3 times per day from a doctor in a clinic setting under strict controls.

HAT Improves Health, Social Functioning and Quality of Life

Peer - reviewed studies around the world have found that HAT is associated with decreased illicit drug use, crime, overdose fatalities, and risky injecting, as well as improvements in physical and mental health, employment and social relations.

In contrast, few reports have appeared in the scientific literature demonstrating any harmful consequences of HAT.

HAT Significantly Reduces Illicit Heroin Use

Importantly, every HAT trial has shown a marked decrease in street heroin use. A Cochrane systematic review concluded, "Each study found a superior reduction in illicit drug use in the heroin arm rather than in the methadone arm...the measures of effect obtained are consistently statistically significant."

For example, the Canadian trial reported a two - thirds (67 percent) reduction in illicit drug use or other illegal activity among HAT participants. Similar reductions in illicit heroin use were reported from HAT trials in the UK (72 percent) and Germany (69 percent).
HAT patients also experience less (and less severe) cravings, helping to explain their decreased use. HAT has also demonstrated an added benefit of reducing participants’ use of alcohol and other drugs.