title: Development of pharmaceutical heroin preparations for medical co-prescription to opioid dependent patients.
abstract: Presently, there is a considerable interest in heroin-assisted treatment: co-prescription of heroin to certain subgroups of chronic, treatment-resistant, opioid dependent patients. In 2002, nine countries had planned (Australia, Belgium, Canada, France, Spain) or ongoing (Germany, The Netherlands, Switzerland, United Kingdom) clinical trials on this subject. These trials (and the routine heroin-assisted treatment programs that might result) will need pharmaceutical heroin (diacetylmorphine) to prescribe to the patients. Research into the development of pharmaceutical forms of heroin for prescription to addicts can benefit from the large amount of knowledge that already exists regarding this substance. Therefore, in this paper we review the physicochemical and pharmaceutical properties of diacetylmorphine and the clinically investigated routes of administration, as well as routes of administration utilised on the street in the context of developing pharmaceutical heroin formulations for prescription to addicts. Patient acceptability of the formulation is essential, because heroin-assisted treatment is aimed at treatment-resistant addicts, who often have to be encouraged to participate (or to maintain participation) in a treatment program. This means that the most suitable products would have pharmacokinetic profiles mimicking that of diacetylmorphine for injection, with rapid peak concentrations of diacetylmorphine and 6-acetylmorphine, ensuring the 'rush effect' and the sustained presence of morphine(-6-glucuronide) creating the prolonged euphoria. Diacetylmorphine for inhalation after volatilisation (via 'chasing the dragon') seems to be a suitable candidate, while intranasal and oral diacetylmorphine are currently thought to be unsuitable. However, oral and intranasal delivery systems might be improved and become suitable for use by heroin dependent patients.
authors.affiliation: Slotervaart Hospital, Department of Pharmacy & Pharmacology P.O. Box 90440, 1006 BK Amsterdam, The Netherlands. apmlk@slz.nl
authors.forename: Marjolein G
authors.initials: MG
authors.lastname: Klous
authors.forename: Wim
authors.initials: W
authors.lastname: Van den Brink
authors.forename: Jan M
authors.initials: JM
authors.lastname: Van Ree
authors.forename: Jos H
authors.initials: JH
authors.lastname: Beijnen
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D011307:Drug Prescriptions; D004351:Drug Resistance; D003932:Heroin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007391:International Cooperation; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D013678:Technology, Pharmaceutical / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid; D003932:Heroin