New Approach to Opioid Crisis: Supervised Heroin Injection Programs?

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THURSDAY, Dec. 6, 2018 — It’s not standard practice in the United States, but supervised access to medical-grade heroin may reduce the risk of harm for heroin addicts unable to kick the habit, new research suggests.

This approach has been successful in other countries and should be tried and studied in the United States, according to a study by the RAND Corporation, a nonprofit global research organization.

“Given the increasing number of deaths associated with fentanyl and successful use of heroin-assisted treatment abroad, the U.S. should pilot and study this approach in some cities,” said study leader Beau Kilmer, co-director of the RAND Drug Policy Research Center.

“This is not a silver bullet or first-line treatment. But there is evidence that it helps stabilize the lives of some people who use heroin,” Kilmer said in a RAND news release.

Specifically, these are people unable to quit heroin after trying traditional treatments such as methadone and buprenorphine, the researchers said.

To assess the effectiveness of heroin-assisted treatment, the researchers examined evidence from Canada, the Netherlands, Switzerland and the United Kingdom.

They found that prescribing heroin injections under medical observation — with optional take-home methadone — has advantages over methadone alone for addicts who have repeatedly tried traditional addiction treatments without success.

While the top priority should be increasing access to traditional treatments, the severity of the U.S. opioid crisis requires other approaches to saving lives, according to the study authors.

Opioid addiction affects about 9 out of every 1,000 Americans and opioid overdose deaths have quadrupled over the past 15 years. More than 49,000 people died from opioid overdoses in the United States in 2017, the researchers said in background notes.

Kilmer and his colleagues also assessed safe injection sites in those other countries — places where addicts can inject drugs purchased on the street. These drug consumption sites can reduce the risk of a fatal overdose, infectious disease transmission and other risks associated with unhygienic drug use, they concluded.

Many such programs have operated for 15 to 30 years and have survived multiple changes in local and national governments, the study team said.

“Persistence does not imply effectiveness, but it seems unlikely that supervised consumption sites — which were initially controversial in many places — would have such longevity if they had serious adverse consequences for their clients or communities,” Kilmer said.

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