title: Heroin-assisted treatment as a response to the public health problem of opiate dependence.
abstract: Injection drug use (involving the injection of illicit opiates) poses serious public health problems in many countries. Research has indicated that injection drug users are at higher risk for morbidity in the form of HIV/AIDS and Hepatitis B and C, and drug-related mortality, as well as increased criminal activity. Methadone maintenance treatment is the most prominent form of pharmacotherapy treatment for illicit opiate dependence in several countries, and its application varies internationally with respect to treatment regulations and delivery modes. In order to effectively treat those patients who have previously been resistant to methadone maintenance treatment, several countries have been studying and/or considering heroin-assisted treatment as a complementary form of opiate pharmacotherapy treatment. This paper provides an overview of the prevalence of injection drug use and the opiate dependence problem internationally, the current opiate dependence treatment landscape in several countries, and the status of ongoing or planned heroin-assisted treatment trials in Australia, Canada and certain European countries.
authors.affiliation: Department of Public Health Sciences, University of Toronto, McMurrich Bldg., 109C, Toronto, ON, M5S 1A8, Canada. benedikt.fischer@utoronto.ca
authors.forename: Benedikt
authors.initials: B
authors.lastname: Fischer
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
authors.forename: Maritt
authors.initials: M
authors.lastname: Kirst
authors.forename: Miguel
authors.initials: M
authors.lastname: Casas
authors.forename: Wayne
authors.initials: W
authors.lastname: Hall
authors.forename: Michael
authors.initials: M
authors.lastname: Krausz
authors.forename: Nicky
authors.initials: N
authors.lastname: Metrebian
authors.forename: Jean
authors.initials: J
authors.lastname: Reggers
authors.forename: Ambros
authors.initials: A
authors.lastname: Uchtenhagen
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
authors.forename: Jan M
authors.initials: JM
authors.lastname: van Ree
mesh_terms: D001315:Australia; D002170:Canada; D002986:Clinical Trials as Topic; D003415:Crime / Q000706:statistics & numerical data; D005060:Europe; D003932:Heroin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D011634:Public Health; D015819:Substance Abuse, Intravenous / Q000188:drug therapy* / Q000534:rehabilitation
chemical_list: D003932:Heroin; D008691:Methadone