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Heroin-assisted treatment: has a controversial treatment come of age?

  • Michael Farrell (a1) and Wayne Hall (a2)

Summary

This editorial considers the findings of the systematic review of heroin-assisted treatment, with six different studies from six different countries, published in this issue. The meta-analysis focuses on supervised injected heroin and reports significant crime reduction and an overall cost-effectiveness of treatment. Despite this body of evidence, policy makers remain reluctant to develop this treatment further. The question remains, what else is required to convince policy makers of the value of such treatment for severe and refractory heroin dependence?

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Copyright

Corresponding author

Michael Farrell, National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia. Email: michael.farrell@unsw.edu.au

Footnotes

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See pp. 5–14, this issue.

Declaration of interest

None.

Footnotes

References

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1 Strang, J, Groshkova, T, Uchtenhagen, A, van den Brink, W, Haasen, C, Schechter, M, et al. Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction. Br J Psychiatry 2015; 207: 514.
2 Spear, B. The early years of the British System in practice. In Heroin Addiction and Drug Policy: The British System (eds Strang, J, Gossop, M): 328. Oxford University Press, 1994.
3 Hartnoll, RL, Mitcheson, MC, Battersby, A, Brown, G, Ellis, M, Fleming, P, et al. Evaluation of heroin maintenance in controlled trial. Arch Gen Psychiatry 1980; 37: 877–84.
4 Marks, J. Management of drug addicts: hostility, humanity, and pragmatism. Lancet 1987; 1: 1068–9.
5 Rihs-Middel, M, Hämmig, R. Heroin-assisted treatment in Switzerland: an interactive learning process combining research, politics and everyday practice. In Heroin-Assisted Treatment: Work In Progress (eds Rihs-Middel, M, Hämmig, R, Jacobshagen, N): 1122. Swiss Federal Office of Public Health, 2005.
6 Rehm, J, Gschwend, P, Steffen, T, Gutzwiller, F, Dobler-Mikola, A, Uchtenhagen, A. Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: a follow-up study. Lancet 2001; 358: 1417–23.
7 Farrell, M, Hall, W. The Swiss heroin trials: testing alternative approaches. BMJ 1998; 316: 639.
8 Ferri, M, Davoli, M, Perucci, CA. Heroin maintenance for chronic heroin-dependent individuals. Cochrane Database Syst Rev 2011; 12: CD003410.
9 Berridge, V. Heroin prescription and history. N Engl J Med 2009; 361: 820–1.
10 McKeganey, N. Should heroin be prescribed to heroin misusers? No. BMJ 2008; 336: 71.

Heroin-assisted treatment: has a controversial treatment come of age?

  • Michael Farrell (a1) and Wayne Hall (a2)

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Heroin-assisted treatment: has a controversial treatment come of age?

  • Michael Farrell (a1) and Wayne Hall (a2)
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