Medical prescription of heroin yields health gains among chronic, treatment-resistant heroin addicts who did not profit sufficiently from existing treatments
The Central Committee on the Treatment of Heroin Addicts (CCBH), which was installed by the Netherlands Minister of Health, has recently completed a large-scale study, which focused on the effect of medical prescription of heroin to chronic, treatment-resistant heroin addicts.
These addicts are in bad physical and psychological health, and most of them are highly dysfunctional in spite of long-term treatment in a methadone maintenance program. The committee concludes that a 12-month treatment of these patients with a combination of heroin and methadone is more advantageous to their medical and social condition than a 12-month treatment with methadone alone.
These gains are lost very soon after discontinuation of the treatment with heroin. The committee, therefore, recommends the introduction under stringent conditions in the Netherlands of supervised medical prescription of methadone plus heroin to chronic, treatment-resistant heroin dependent patients as a last-resort pharmacotherapeutic option.
Out of the estimated 25,000 heroin addicts in the Netherlands, approximately 13,000 are treated in methadone maintenance programs. About 5,000 of them are doing well. They are not using illegal drugs any longer, are in good health, and are socially reintegrated. The remaining 8,000 methadone treated patients are not profiting sufficiently from this treatment. In spite of their participation in the methadone program, these patients continue to use illegal drugs, often engage in criminal activities, are in poor health, and lead a marginalised existence.
In 1996, the Netherlands Minister of Health commissioned the CCBH to conduct a study that would focus on the beneficial and adverse effects of supervised dispensation of heroin to chronic, treatment-resistant heroin addicts, who did not sufficiently profit from participation in a methadone maintenance program.
Between 1998 and 2001, 549 patients were included in one of two randomised controlled trials: 174 in a trial for patients who are predominantly injecting heroin and 375 patients in a trial for patients who are predominantly inhaling heroin. In these trials, patients who received heroin and methadone for 6 or 12 months were compared with patients who received methadone alone during the same period. In addition, the effect of discontinuation of heroin treatment after 6 or 12 month was investigated.
The results of the study indicate that treatment with heroin in combination with methadone is more effective than treatment with methadone alone. The proportion of patients with a favourable response in the group that received heroin was 20-25% higher than in the group that received methadone alone. A favourable response was defined as clinically relevant improvements in physical and psychological health as well as improvements in social functioning, including reductions in criminality. The medical co-prescription of heroin resulted in a modest decrease in the consumption of cocaine.
Two months after the discontinuation of the treatment with heroin, the condition of more than 80% of the patients had seriously deteriorated and health gains were lost entirely.
The study also showed that supervised medical co-prescription of heroin is safe and controllable and does not increase public order problems.
Based on these results, the CCBH recommends: (1) the introduction under stringent conditions in the Netherlands of supervised medical prescription of methadone plus heroin to treatment-resistant heroin addicts as a last-resort pharmacotherapeutic option; (2) the promotion of an application for registration of heroin as a medicinal product; and (3) the development of a quality assurance system for the medical prescription of heroin.
The report with the first results, conclusions and recommendations will be presented to the Netherlands Minister of Health on Monday 4 February 2002 at 10.30 a.m. in The Hague (Nieuwspoort).