Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-06T03:54:27.017Z Has data issue: false hasContentIssue false
  • English
  • Français

Heroin prescription for heroin addiction – an English view

Published online by Cambridge University Press:  24 June 2014

Tom Carnwath
Tom Carnwath*
Affiliation:
Pierremont Unit, Darlington, UK
*
Dr Tom Carnwath, Pierremont Unit, Hollyhurst Road, Darlington DL3 6HX, UK. Tel.: 01325 743 844. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Heroin has been prescribed in England for the treatment of heroin addiction for almost 100 years. For many years, England was almost the only country where this occurred, and the British system was consequently the subject of international curiosity. In spite of this long history, very little research has been carried out locally, and until recently, there were no guidelines as to best practice. In 1965, it was decided that only doctors with a Home Office license could prescribe heroin. Since that time, the proportion of opiate addicts treated with heroin has greatly diminished, as has the number of doctors willing to prescribe. One doctor in particular remained an enthusiastic proponent of heroin prescription. His claims impressed some Swiss clinicians, who proceeded to establish a multicentre trial in Switzerland. This was followed by a similar trial in the Netherlands. These trials apparently indicated that a proportion of treatment-resistant opiate addicts could respond well to heroin, although the researchers' conclusions have been disputed. The National Treatment Agency in England is now developing guidelines for good practice based on this new information and is planning to set up some pilot sites. It is likely that practise in England will remain somewhat different from continental practice, particularly with respect to long-term supervised injecting. It is unclear how much funding will be released to support heroin prescription. Without adequate funding, it is likely to disappear.

Keywords

herointreatmentdrug dependenceinjectables; UK
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 16 , Issue 5 , October 2004 , pp. 275 - 280
Copyright
Copyright © 2004 Blackwell Munksgaard

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

National Treatment Agency. Injectable heroin (and injectable methadone) – potential roles in drug treatment. London: National Treatment Agency, 2003. Also available at http://www.nta.nhs.uk.Google Scholar
House of Commons Home Affairs Committee– Third Report. The Government's Drug Policy: is it working? London: HMSO, 2003 (paragraph 195).Google Scholar
Carnwath, T, Smith, I. Heroin century. London: Routledge, 2002. Google Scholar
Ministry of Health. Drug addiction: report of the Departmental Committee on Morphine and Heroin Addiction. London: HMSO, 1926. Google Scholar
Musto, DF. The American disease: origins of narcotic control. New York: Oxford University Press, 1999: p. 132. Google Scholar
Symposium on the proposed legislation banning the legal production of heroin in Great Britain. Br J Addict 1956;53: 39–50.CrossRefGoogle Scholar
Trebach, AS. The heroin solution. New Haven: Yale University Press, 1982. Google Scholar
Ministry of Health and Department of Health for Scotland Drug Addiction. Report of the Interdepartmental Committe. London: HMSO, 1961. Google Scholar
The Ministry of Health and Scottish Home and Health Department. Drug addiction: the second report of the Interdepartmental Committee. London: HMSO, 1965. Google ScholarPubMed
Dole, V, Nyswander, M. A medical treatment for diacetylmorphine (heroin) addiction. J Am Med Assoc 1965;193: 80–84. CrossRefGoogle ScholarPubMed
Stimson, GV, Metrebian, N. Prescribing heroin. York: Joseph Rowntree Foundation, 2003. Google Scholar
Hartnoll, RL, Mitcheson, MC, Battersby, Aet al. Evaluation of heroin maintenance in a controlled trial. Arch Gen Psychiatry 1980;37: 877–884.CrossRefGoogle Scholar
Carnwath, T, Merrill, J. Dose equivalents in opioid substitution treatment. Int J Drug Policy 2002;13: 445–447. CrossRefGoogle Scholar
Berridge, V, Thom, B. The relationship between research and policy: case studies from the postwar history of drugs and alcohol. Contemp Drug Probl 1994;21 (4):599–629. CrossRefGoogle Scholar
Advisory Committee on the Misuse of Drugs AIDS and Drug Misuse, Update. London: HMSO, 1993. Google Scholar
Strang, J, Sheridan, J. Heroin prescribing in the ‘British System ‘of the mid 1990s: data from the 1995 national survey of community pharmacies in England and Wales. Drug Alcohol Rev 1997;16: 7–16. CrossRefGoogle ScholarPubMed
Strang, J, Sheridan, J, Barber, N. Prescribing injectable and oral methadone to opiate addicts: results from the 1995 national postal survey of community pharmacies in England Wales. Br Med J 1996;313: 270–272. CrossRefGoogle Scholar
Home Office. Tackling drugs to build a better Britain. London: HMSO, 1998. Google Scholar
Coid, J, Carvell, A, Kittler, Z, Healey, A, Henderson, J. The impact of methadone treatment on drug misuse and crime. London: Home Office, 2000 (research findings no. 120).Google Scholar
Metrebian, N, Carnwath, T, Stimson, GV, Storz, T. Survey of doctors prescribing diamorphine (heroin) to opiate-dependent drug users in the United Kingdom. Addiction 2002;97 (9):1155–1161.CrossRefGoogle ScholarPubMed
Zador, D. Injectable opiate maintenance in the UK: is it good clinical practice? Addiction 2001;96: 547–553.CrossRefGoogle ScholarPubMed
McCusker, C, Davies, M. Prescribing drug of choice to illicit heroin users: the experience of a UK community drug team. J Subst Abuse Treat 1996;13: 521–531.CrossRefGoogle Scholar
Uchtenhagen, A, Dobler-Mikola, A, Steffen, T, Gutzwiller, F, Blattler, R, Pfeiffer, S. Prescription of narcotics for heroin addicts. Main results of the Swiss National Cohort Study. Basel: Karger, 1999. CrossRefGoogle Scholar
Perneger, TV, Giner, F, Del Rio, M, Mino, A. Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments. Br Med J 1998;317: 13–18. CrossRefGoogle ScholarPubMed
Ali, R, Auriacombe, M, Casas, Met al. Report of the external panel on the evaluation of the Swiss scientific studies of medically prescribed narcotics to drug addicts. WHO: Geneva, 1999. Google Scholar
van den Brink, W, Vincent, M, Hendriks, VM, Blanken, P, Huijsman, IA, Van Ree, JN. Medical co-prescription of heroin: two randomized controlled trials. Utrecht: Central Committee on The Treatment of Heroin Addicts, 2002. Also available at http://www.ccbh.nl.Google Scholar
Reed, LJ, De Wet, C, Bearn, J. Prescription of heroin to treatment resistant heroin addicts: replacement therapies need to be tested on a level playing field. BMJ 2004;328: 228 (letter).CrossRefGoogle ScholarPubMed
Caplehorn, J. Prescription of heroin to treatment resistant heroin addicts: Dutch heroin trials show retention is better with methadone alone. BMJ 2004;328: 228–229 (letter).CrossRefGoogle ScholarPubMed
Dehue, T. Prescription of heroin to treatment resistant heroin addicts: double blinding is not possible. BMJ 2004;328: 228 (letter).CrossRefGoogle Scholar
van den Brink, W, Blanken, P, Hendriks, VM. Prescription of heroin to treatment resistant heroin addicts: authors’ reply. BMJ 2004;328: 229 (letter).CrossRefGoogle Scholar
Home Office. Updated drug strategy. London: HMSO, 2002. Google Scholar
Luty, J. New guidelines for prescribing injectable heroin in opiate addiction. Psychiatr Bull (in press).Google Scholar
Metrebian, N, Shanahan, W, Stimson, GVet al. Prescribing drug of choice to opiate dependent drug users: a comparison of clients receiving heroin with those receiving injectable methadone at a West London drug clinic. Drug Alcohol Rev 2001;20: 267–276. CrossRefGoogle Scholar