Heroin-Assisted Treatment: A Closer Look at a Forbidden Possibility
In drug maintenance therapies for opioid addiction, less dangerous narcotics called methadone and buprenorphine are substituted for heroin and prescription painkillers. Doses are administered in a clinical setting and over time an attempt is made to phase out the maintenance drugs and eliminate opioid dependency entirely. Legally obtained methadone and buprenorphine have become increasingly popular with addiction specialists looking to guide their patients back to good health, as drug replacement therapy has been shown to produce excellent results in both controlled studies and real-world conditions.
But on a worldwide basis, methadone and buprenorphine are not the only options for treatment professionals interested in trying drug maintenance therapy. In a half-dozen European countries, heroin itself, in synthetic form, is also being used as a replacement drug to help addicts control their heroin dependency.
This form of treatment is usually reserved for addicts who have not found success in methadone or buprenorphine maintenance programs, making it more of a last resort than a first line of defense. Heroin-assisted treatment, or HAT, is always applied in conjunction with a more traditional rehabilitation regime, which includes psychological counseling, social services, 12-step peer group interactions and other intervention strategies that have a history of success.
Each day, addicts in heroin-assisted treatment programs are required to show up at their doctors’ offices to receive their synthetic heroin injections. Two doses per day are standard in most countries, usually combined with a separate injection of methadone to bridge the time gap between the heroin shots. The methadone helps to reduce the incidence of cravings, which can become a problem for heroin addicts whose bodies have become conditioned to expect high levels of opioids in the bloodstream. The replacement of street heroin with heroin produced in the laboratory is not intended to be a permanent solution, but a safer, more controlled alternative to unsupervised habitual use.
Heroin-assisted treatment was first used in Switzerland in the mid-1990s. The country was experiencing a heroin epidemic at the time, and public health officials were looking for ways to increase the effectiveness of standard treatment approaches. The decision to distribute heroin in a clinical setting was controversial, since in the minds of many it seemed to indicate a tacit approval of illegal drug use. But right from the get-go, HAT proved highly successful, and heroin addiction rates in Switzerland have dropped dramatically since the drug’s heyday. Nearly identical HAT programs have since been instituted in the United Kingdom, Germany, Denmark, the Netherlands and Belgium, while in Spain and Canada, HAT is being made available to a limited number of addicts participating in clinical trials.
Heroin-Assisted Treatment Works, Say European Union Health Officials
Numerous articles assessing the effectiveness of HAT have been published in peer-reviewed medical journals over the last decade. Virtually all of these reports have been positive, confirming the usefulness of heroin-assisted treatment for addicts unable to find sobriety after undergoing more traditional forms of drug rehab.
In order to reach a definitive conclusion about the effectiveness of HAT, the European Union’s Monitoring Centre for Drugs and Drug Addiction (EMCDDA) performed a comprehensive evaluation of all the available information. Researchers involved in this study used data collected from six major randomized controlled trials carried out in various countries, plus the results of a meta-analysis undertaken by the prestigious Cochrane Collaboration, a nonprofit group that advocates for evidence-based health care reform.
The EMCDDA’s findings were published in the April 2012 edition of its journal Insights, and once again the utility of heroin-assisted treatment was validated. Some of the more significant changes observed in recovering addicts who participated in HAT programs included:
- Reduced use of illegal heroin obtained and injected outside of a clinical setting (67, 72 and 69 percent reductions were found in studies carried out in Canada, Great Britain and Germany, respectively).
- Decreased involvement in criminal activity directly or indirectly related to substance abuse (illegal drug-dealing, theft of money or property, spousal or child abuse, etc.).
- A dramatically reduced likelihood of drug overdose (the administration of synthetic heroin only takes place in medical facilities and is always closely supervised).
- Lower rates of HIV and hepatitis C infection (these diseases are usually contracted by drug addicts through needle-sharing).
- Improved state of overall physical and emotional health and well-being.
- Enhanced ability to reintegrate into society (hold down a job, find a place to live, keep medical appointments, pay bills on time, maintain good family relationships, etc.).
- A stronger commitment to ongoing participation in comprehensive, lifelong addiction treatment programs.
Heroin-assisted treatment is designed to quickly eliminate the imminent dangers addicts face from their continued use of an illicit substance in uncontrolled conditions. HAT meets the addict halfway between drug dependency and sobriety, slowly but surely helping to guide lost souls back to health and independence. Drug addicts are no longer forced to hide in the shadows wallowing in shame, but are instead treated as legitimate medical patients trying hard to overcome a serious disease.
Does Heroin-Assisted Treatment Have a Future in the United States?
Regrettably, heroin-assisted treatment cannot even be studied in the United States, let alone instituted in difficult cases. In fairness to skeptics, giving heroin to heroin addicts does seem counterintuitive, and an initial knee-jerk reaction against the idea is understandable. But in the field of addiction, promoting and prioritizing evidence-based treatments is vital to the health and welfare of addicts, and to the public as a whole. Objective, peer-reviewed analysis of HAT has found it to be highly useful in a subset of heroin addiction cases.
The taboo status of heroin is justified to some extent. But that should not prevent medical science from taking a good long look at heroin-assisted treatment, which we already know can help addicts subdue their habits and resume their normal lives.