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Researchers Debate Merits of Prescription Heroin for Addicts

Favorable side cites positive health, social outcomes; unfavorable side raises ethical issues

FRIDAY, Jan. 11 (HealthDay News) -- In the management of patients with heroin addiction, prescription heroin may or may not be an ideal strategy, according to a "Head to Head" debate published in the Jan. 12 issue of the BMJ.

Arguing in favor of prescription heroin, Jurgen Rehm, Ph.D., and Benedikt Fischer, M.D., of the Centre for Addiction and Mental Health in Toronto, Ontario, Canada, cited studies from Switzerland, Germany and the Netherlands showing that the practice reduced epileptic episodes, abscesses or cachexia; improved mental health outcomes such as affective or anxiety disorders; and decreased heroin and cocaine misuse and associated crimes such as property theft and drug trafficking. They also reported that heroin maintenance was cost beneficial in Switzerland and cost effective in the Netherlands compared to methadone maintenance.

Arguing against prescription heroin, Neil McKeganey, Ph.D., of the University of Glasgow in Scotland, said the studies do not clearly show whether or not the improved outcomes are primarily due to prescribed heroin or to other elements of the therapeutic programs. He also cited statistics showing that heroin maintenance is three to four times more costly than methadone maintenance and stated that heroin maintenance would cede prescription authority to patients because it only treats the effects of heroin misuse instead of the addiction itself.

"Overall, we see no convincing reason why heroin assisted maintenance treatment should not be part of a comprehensive treatment system for opioid dependence," Rehm and Fischer state. "Health services need to ensure that they are supporting addicts' attempts to become drug free, and they need to be extremely cautious about any extension of a policy that could be seen as a route to maintaining rather than reducing an individual's drug dependency," McKeganey concludes.

Pro: Rehm and Fischer
Con: McKeganey

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