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I read with interest the story highlighted on today’s Daily Dose, Swiss approve prescription heroin.
It seems that since the pilot project had started 14 years ago in Zurich then spreading across the rest of Switzerland it has helped in various ways, getting long-term addicts out of Switzerland’s once notorious “needle parks” and reducing drug-related crime.
The final results from the national referendum showed 68% of voters supported the plan to continue the prescribing policy with Switzerland being the first country to include it in government policy.
Why is it that the policy makers in the UK aren’t looking into similar plans for those people that all other treatment modes have failed to help? Every time I read of such programs, wherever they are in the world, it seems that they are having positive results. It makes me angry that we could be failing to reach out and help people that are crying out for help.
Whether or not a similar project in the UK would actually prescribe dia-morphine or just give people a safe, clean environment to inject their own, illegal drugs; it would drastically reduce the incidence of overdose and also provide an invaluable ‘first contact’ with specialised drugs workers, enabling the possibility of entering structured treatment and also the receiving of other help for mental health problems and the like.
At this time, with substance misuse affecting so many people either directly or indirectly, we need to be doing all we can to help change the situation for the better and not simply to continue burying our heads in the sand.
It would be very interesting to see what other people’s thoughts were on the points I’ve raised so please let me know by commenting!
From a harm minimisation approach it makes sense, I have seen blood clots, amputations, deaths…. the list goes on. Not to mention the violence that goes hand in hand with the illegal drugs trade. It would be interesting to see what society would be like 10 or 20 years on from such a policy in the UK. It is definitely a topic for debate, I will ask for some of my clients views on this.
Nice one for bringing the topic up Kev.
Actually there is a significant project going on in the UK and there has been interest in reviving injectable heroin prescription for a long time in this country. The RIOTT trial (Randomised Injectable Opioid Treatment Trial) has been running for the last couple of years at 3 supervised injecting clinics in London, Darlington and Brighton. The trial was comparing injectable heroin with injectable methadone and optimised oral methadone. The costs of the clinics themselves were met by the NTA. The results are to be published soon and it appears that for many participants they did achieve stabilisation in their lives more than they did when receiving other forms of treatment and they did reduce their illicit heroin use somewhat. The treatment is quite expensive as the injecting is medically supervised in clinics that are open 365 days a year, and the heroin which is imported from Switzerland is surprisingly costly as well. Professor John Strang was quoted recently as saying the heroin treatment costs £15000 per year. As the treatment is aimed at those who have failed to respond to other treatments it is estimated that around 6000 users may be eligible if the this is rolled out nationally. That could cost £90 million per year. Whether this type of treatment is supported in the future will depend on political and health economic considerations. There is a plan to keep the project going and research a longer term follow-up, which is probably a good idea. I personally feel this provision is legitimate for those that have tried other treatment and repeatedly failed, but I have my doubts whether there will be much political or public support for it. The Swiss are quite unusual in their enthusiasm for it: the Canadians and Australians are far less keen.
I was involved in trying to recruit people to the RIOTT trials in the North West. I was amazed how few people were interested once they were told the conditions. Loads of people wanted to know more about maintenance diamorphine but once you explained what they had to do to get it the interest dropped right off. Some of the supporters of the scheme (the police, local authority community safety etc) who were interested in supporting it as a crime reduction inititaive also lost interest when they understood the conditions. They (the crime reduction people) wanted addicts in their crime committing prime to be admitted. When they realised that you could get on only after you had failed to respond to other treatments, they realised that it would be the older people who had reduced a lot of their offending anyway and they lost interest.
That is very interesting Mark. The NAOMI (North American Opiate Medication Initiative) controlled trial in Canada, which at $8million is one of the most expensive clinical trials ever conducted in Canada, despite quite loose eligibility criteria, managed to recruit only 85 subjects in the whole of 2005 and and one of the sites (in Toronto) had to close because of difficulties recruiting subjects in the pilot phase.
I think RIOTT did get close to its original recruitment target of 150 (50 in each condition) but it doesn’t seem to have been that easy.
Very enlightening comments – great to read.
Mark – I’m wondering what these conditions you refer to were? And also whether it is planned to change such conditions in any future trials?
The conditions are basically that you need to come into a medical setting several times a day and inject the diamorphine in the company of nurses. In short, its a very clinical setting a million miles away from the usual setting of injecting drug use. I dont know of any propsal to make the setting more conducive and attractive. I’m not sure how you could do it without allowing people to take it home and inject at home.
