NETHERLANDS CONSIDERS PRESCRIBING HEROIN TO ADDICTS

The combined prescribing of heroin and methadone on medical grounds to long
term users of heroin is safe and manageable and has health benefits over
ordinary methadone programmes, two large randomised controlled trials in
the Netherlands have concluded.

Prescribing heroin to up to 2000 addicts for whom no other medical
treatment has proved effective now looks likely.

The trials were carried out on 549 patients in six cities between 1998 and
2001 by the Central Committee on the Treatment of Heroin Addicts. The
committee was set up by the Dutch health minister in 1996 to look at the
intended and unintended effects of medical prescription of heroin to
"chronic, therapy resistant addicts" (BMJ 1995;310:1625).

Patients in one group were prescribed heroin and methadone for six or 12
months, while a control group received only methadone. The effect of
discontinuing heroin treatment was also investigated.

Patients who were prescribed heroin and methadone experienced 23-25% more
"clinically relevant improvements" in their physical, mental, or social
condition than patients taking methadone alone. The improvements included
better social contacts, less criminality, and less use of cocaine. 90% of
all the patients had previously been heavy users of cocaine.

The follow up study showed that within two months of stopping the treatment
more than 80% of the patients lost all health gains.

The studies also conclude that prescribing heroin can be safe. Three
patients died during the studies, which involved the dispensing of heroin
140 000 times. This is less than half the death rate in methadone programmes.

The committee now recommends that combined heroin and methadone treatment,
under strict conditions and as a last medical option, should be introduced
as part of Dutch addiction care and that the registration of heroin as a
medicine should be promoted and a "quality system" developed for
prescribing the drug.

Health minister Els Borst will put the recommendations to parliament, where
MPs are expected to support them. She is keen to base policy on evidence,
not ideology, and praised the research for its "unique" scientific framework.

The average patient in the studies was 39 years old with a 16 year
addiction. The heroin was dispensed at a clinic three times a day for
smoking or injecting under medical supervision, enabling close contact
between patients and medical staff.

Of an estimated 25 000 people in the Netherlands with a heroin addiction,
13 000 are treated on methadone programmes but for 8000 of these methadone
treatment is deemed ineffective, because of criminality and use of other drugs.

The results of the trial can be accessed on the committee's website at
www.ccbh.nl