Saturday, 16 August 2008

Prescription Heroin - Lifesaving Medication?

As the results from Canada and Britain’s heroin trials approach, have written an article about the positive outcomes of prescription heroin. A little known fact is that in Britain, heroin can already be prescribed for addiction under certain circumstances. The reality though is that because of the US’s obsession with prohibition and the pressure from the International Narcotics Control Board (INCB), heroin is rarely prescribed anymore, if at all.

Here is an extract from that article.

Role Reversal

By Mike Aston & John Witton

Controversial, expensive, yet promising so much, interest is increasing in prescribing heroin to heroin addicts. Its the drug fields ultimate role reversal from killer drug to lifesaving medication. Just five studies hold the answers to whether it can work. 

Led by government ministers frustrated at slow progress in the fight against serious drug problems, Britain is about to revive its acquaintance with heroin not as a drug of abuse, but as a treatment for drug abuse. Heroin prescribing has traditionally been the main distinguishing feature of what was seen as the “British system” for responding to heroin addiction. It rested on the unique legal leeway afforded doctors in Britain, until recently the only nation which allowed heroin (in its pharmaceutical form called diamorphine) to be prescribed for the treatment of addiction. Before 1968, any doctor could exercise this prerogative. Since then the treatment has been restricted to specialists who hold the requisite Home Office licence, nearly all of whom work in NHS drug dependence clinics. 

At first the dominant response to the 1960s UK heroin outbreak, soon diamorphine prescribing waned to be replaced by injectable and then oral methadone. Of the 70 or more licensed doctors today, perhaps 50 prescribe diamorphine (almost entirely in injectable form) to just 450 patients. An increase in these numbers can be expected to flow from the commitment in the UK

Why consider diamorphine?

The “Why bother?” question is the main one diamorphine has to answer. After all, Britain has spent the last 30 years moving away from diamorphine and towards oral methadone, a treatment with substantial research backing and which benefits many thousands of patients. Only if there are substantial extra benefits compared to oral methadone might the extra costs and risks be justified. Even then there would remain the issue of whether injectable methadone might provide the same benefits yet permit a less drug-dominated lifestyle - injecting once rather than three times a day and less pronounced mood swings. 

The potential advantages of diamorphine derive from its anticipated pulling power for heroin addicts, defined traditionally and legally in Britain as having an “overpowering desire” for the chemical. Those who find methadone unappealing or for whom it fails to curtail heroin use might be attracted and retained by diamorphine, extending the benefits of maintenance therapy - social stabilisation, risk and crime reduction, health improvements - to yet more patients. 

The same pulling power is the source of diamorphine’s potential drawbacks. Once known to be an option, new patients who would have been satisfied with and done well on oral methadone may demand diamorphine. They may even deliberately fail on methadone to “qualify” for the drug. Once in diamorphine treatment, relatively safe, hassle-free and cash-free access to their drug of choice might prolong patients’ careers as addicts and as patients. Injectable diamorphine maintains the frequency of injecting with its associated risks. As in the 1960s, addicts may sell all or part of their diamorphine, spreading addiction and risking the purchasers’ lives, yet preventing this by requiring thrice daily attendance for supervised injection is costly and unpopular with patients. 

Establishing the validity of these hopes and fears sets the agenda for this review.

Read the entire article:

1 comment:

Anonymous said...

Interesting to read the latest results from five years age, what's happenig now?