Prescribing heroin to addicts could be cheaper and more effective than methadone, says expert

Professor Martin Schechter says the drug should be used after traditional treatment fails

Lizzie Dearden
Wednesday 15 April 2015 12:35 BST
Professor Martin Schechter argues that pure heroin can treat addicts more cheaply and effectively
Professor Martin Schechter argues that pure heroin can treat addicts more cheaply and effectively

Prescribing heroin to addicts trying to beat their addiction could be cheaper and more effective than replacement therapy, an expert has claimed.

Methadone, a synthetic opiate, is commonly used to wean people off the drug, while other patients are put through detoxification and abstinence programmes.

But Professor Martin Schechter, from the University of British Columbia in Vancouver, Canada, said there was “overwhelming” evidence that these standard treatments do not work for a section of addicts.

Most street heroin is below 50% purity but diamorphine, its purest form, has been prescribed by doctors abroad

Writing in the British Medical Journal (BMJ), he said: “Illicit heroin is a dangerous street drug that leads to substantial morbidity and mortality. Because its dose and purity are unknown, users will face the risk of overdose and death.”

Addicts will be in and out of hospitals and prisons and “cost society a fortune while suffering immeasurably because they have an illness that society does not like”, he added.

Heroin’s status as one of the most tightly controlled drugs in the world means possession carries harsh penalties in many countries – up to seven years imprisonment in the UK – and addicts using it illicitly engage in unsafe practices like sharing HIV-infected needles.

Professor Schechter noted the findings of six randomised controlled trials that found heroin-assisted treatment to be more effective for patients who had found standard therapy ineffective.

Professor Martin Schechter argues that the illicit use of heroin increases the danger of death

He also highlighted a recent review concluding that medically supervised use of the drug can improve compliance while reducing illicit use, crime, imprisonment and the likelihood of death.

Professor Schechter claimed that although the use of diamorphine - pure heroin - can be up to four times more expensive than methadone, it works out cheaper in the long term because of associated costs and the duration of the treatment.

A trial in the Netherlands showed that heroin assisted therapy made overall savings of around €13,000 (£9,530) per patient every year, when compared to methadone, and a group of British researchers also found that heroin-assisted therapy was more cost effective than oral methadone.

“The argument that therapeutic heroin is too expensive is false,” Professor Schechter wrote.

“Treatments like this represent the holy grail of medical research seeking to support a sustainable health system: they achieve better outcomes at lower overall cost.”

Methadone, a synthetic opiate developed in Nazi Germany, is widely prescribed on the NHS

He would see those savings put into addiction prevention programmes and other associated schemes.

Professor Schechter argued that conventional treatment should still be the first port of call for addicts but heroin should be prescribed, safely by doctors at specialised clinics, if that does not work.

The NHS currently prescribes methadone and buprenorphine to heroin addicts to minimise withdrawal symptoms while they undergo counselling and other therapy.

Once patients are “stabilised”, they are offered the choice of coming off substitute drugs completely and detoxing either at home or in a rehabilitation centre.

The argument for prescribing heroin has been made numerous times in recent years and while serving as Justice Secretary in 2009, Jack Straw called for its use to treat the “most problematic” addicts.

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