Heroin-assisted treatment as a response to the public health problem of opiate dependence.
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.
Fischer
Benedikt
B
Department of Public Health Sciences, University of Toronto, McMurrich Bldg., 109C, Toronto, ON, M5S 1A8, Canada. benedikt.fischer@utoronto.ca
Rehm
Jürgen
J
Kirst
Maritt
M
Casas
Miguel
M
Hall
Wayne
W
Krausz
Michael
M
Metrebian
Nicky
N
Reggers
Jean
J
Uchtenhagen
Ambros
A
van den Brink
Wim
W
van Ree
Jan M
JM
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
D003932:Heroin; D008691:Methadone