Heroin Maintenance Treatment - Are the Further Investigation Needed?

Open access

Abstract

The aim of this review is to give new emphasis to key aspects of the proposed treatment of drug addiction. Surveys for so called “second-line” treatment of drug addiction, with heroin (diacetylmorphine) as a pharmaceutical preparation, started since 1990, but this issue is becoming particularly popular in the last period. Drug addiction according to WHO and International Classification of Diseases (ICD10) is chronic, relapsing disease characterized by compulsive drug seeking and use despite harmful consequences as well as neurochemical and molecular changes in the brain. Drugs generate crime, violence and other social problems that are damaging society as a whole. Drug addiction is medical disorder to which contributes more factors and it is necessary to implement the treatment in multi disciplinary manner - from pharmacological, psychiatric, and social aspect. In recent periods studies are carrying out in several countries in the European region, to provide justification, with the scientific medical evidence, for use of heroin as a pharmaceutical dosage form, for treatment of drug addictions for previously unresponsive group. This review paper is focused on maintenance treatment with heroin, retention of the patients into treatment, whether the dose that is expected to be effective at the same time is safe, which organ (systems) are involved in eliminating the drug from the body, whether the injection is the best way for application of the drug. Purpose of this review paper is not to be supporter or opponent, but to inform, transparently to discuss all aspects and to set conclusions about this type of treatment, within national strategy context.

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  • 1. Joint UNODC-WHO Action Programme On Drug Dependence Treatment Scaling Up Evidence-Based Services For Drug Dependence Treatment And Care for 2009-2013 2008.

  • 2. Afuwape SA. Where are we with dual diagnosis (substance misuse and mental illness)?

  • 3. A review of the literature November 2003 Rethink and Turning Point www.rethink.org/dualdiagnosis.

  • 4. www.drugabuse.gov.

  • 5. Ward J Bell J Mattick RP. Methadone maintenance therapy for opioid dependence: A guide to appropriate use. CNS Drugs. 1996;6(6):440-9.

  • 6. Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence World Health Organization 2009

  • 7. Dole VP Robinson JW Orraca J Towns E Searcy P Caine E. Methadone treatment of randomly selected criminal addicts. The New England journal of medicine. 1969;280(25):1372-5.

  • 8. Gowing LR Farrell M Bornemann R Sullivan LE Ali RL. Brief report: Methadone treatment of injecting opioid users for prevention of HIV infection. J Gen Intern Med. 2006;21(2):193- 5.

  • 9. Gronbladh L Ohlund LS Gunne LM. Mortality in heroin addiction: impact of methadone treatment. Acta psychiatrica Scandinavica. 1990;82(3):223-7.

  • 10. Newman RG Whitehill WB. Double-blind comparison of methadone and placebo maintenance treatments of narcotic addicts in Hong Kong. Lancet. 1979;2(8141):485-8.

  • 11. Lenne M Lintzeris N Breen C Harris S Hawken L Mattick R et al. Withdrawal from methadone maintenance treatment: prognosis and participant perspectives. Australian and New Zealand journal of public health. 2001;25(2):121-5.

  • 12. UN Convention for narcotic drugs 1961 UN Convention for psychotropic substances 1972 UN Convention against illicit production and trafficking with narcotics 1988.

  • 13. UNODC (2011). World Drug Report. UNITED NATIONS OFFICE ON DRUGS AND CRIME.

  • 14. UNODC World Drug Report 2009.

  • 15. Journal of epidemiology & community health http://jech.bmj.com/content/58/9/747.full

  • 16. Teesson M Ross J Darke S Lynskey M Ali R Ritter A and Cooke R. One year outcomes for heroin dependence: findings from the Australian Treatment Outcome Study (ATOS). Drug & Alcohol Dependence 2006;83(2):174-180.

  • 17. Hser YI Anglin MD and Fletcher B. Comparative treatment effectiveness. Effects of program modality and client drug dependence history on drug use reduction. Journal of Substance Abuse Treatment. 1998;15(6):513-523.

  • 18. Strang J Groshkova T Metrebian N. Emcdda insights. New heroin-assisted treatment Recent evidence and current practices of supervised injectable heroin treatment in Europe and beyond 2012.

  • 19. Metrebian N Shanahan W Wells B Stimson GV Department of Social Science and Medicine Imperial College School of Medicine London United Kingdom Feasibility of prescribing injectable heroin and methadone to opiatedependent drug users: associated health gains and harm reductions. Med J Aust. 1998;168(12):596-600.

  • 20. van den Brink W Hendricks VM Blanken P et al. (2003) ‘Medical prescription of heroin to treatment resistant heroin addicts: two randomised trials’ British Medical Journal. 2003; 327:310-316.

  • 21. March JC Oviedo-Joekes EPerea-Milla E Carrasco F Andalusian School of Public HealthGranada 18080 Spain Controlled trial of prescribed heroin in the treatment of opioid addiction J Subst Abuse Treat. 2006:31(2)203-11.

  • 22. Rehm J Gschwend P Steffen T Gutzwiller F Dobler-Mikola A Uchtenhagen A. Addiction Research Institute Zurich Switzerland Feasibility safety and efficacy of injectable heroin prescription for refractory opioid addicts: a follow-up study. Lancet. 2000;359(9309):889-90.

  • 23. McCusker C Davies M. Department of Clinical Psychology School of Psychology Queen’s University of Belfast Northern Ireland. Prescribing drug of choice to illicit heroin users: the experience of a U.K. community drug team.

  • 24. Kerr T Montaner JS Wood E. Science and politics of heroin prescription. Lancet. 2010;375(9729):1849-50.

  • 25. Naber D Haasen C. Centre for Interdisciplinary Addiction Research of Hamburg University. The German Model Project for Heroin Assisted Treatment of Opioid Dependent Patients - A Multi-Centre Randomised Controlled Treatment Study: Clinical Study Report of the First Study Phase January 2006.

  • 26. Strang et al. Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial. Lancet. 2010;375(9729).

  • 27. Csete J. From the Mountaintops: What the World Can Learn from Drug Policy Change in Switzerland. Global Drug Policy Program (New York NY: Open Society Foundations May 2010).

  • 28. EMCCDA. Annual Report 2010. http:// www.emcdda.europa.eu/events/2010/annual-report.

  • 29. Farrell M. National Addiction Centre Institute of Psychiatry London SE5 8AF Wayne Hall. The Swiss heroin trials: testing alternative approaches BMJ. 1998;316(7132): 639.

  • 30. Carnwath T Merrill J. Dose equivalents in opioid substitution treatment. International Journal of Drug Policy. 2002;13:445-447.

  • 31. Rook EJ Huitema AD van den Brink W van Ree JM Beijnen JH. Pharmacokinetics and pharmacokinetic variability of heroin and its metabolites: review of the literature. Curr Clin Pharmacol. 2006;1(1):109-18.

  • 32. Farrell M Hall W. The Swiss heroin trials: testing alternative approaches. BMJ. 1998;316(7132):639.

  • 33. Mo BP Way EL. An assessment of inhalation as a mode of administration of heroin by addicts. J Pharmacol Exp Ther. 1966;154:142-51.

  • 34. Elliott HW Parker KD Wright JA Nomof N. Actions and metabolism of heroin administered by continuous intravenousinfusion to man. Clin Pharmacol Ther. 1971;12: 806-14.

  • 35. Faura CC Collins SL Moore RA McQuay HJ. Systematic review of factors affecting the ratios of morphine and its major metabolites. Pain. 1998; 74: 43-53.

  • 36. Mo BP Way EL. An assessment of inhalation as a mode of administration of heroin by addicts. JPharmacol Exp Ther. 1966;154:142-51.

  • 37. Elliott HW Parker KD Wright JA Nomof N. Actions and metabolism of heroin administered by continuous intravenous infusion to man. Clin Pharmacol Ther. 1971;12:806-14.

  • 38. Kreek MJ Schecter AJ Gutjahr CL Hecht M. Methadone use in patients with chronic renal disease. Drug Alcohol Depend. 1980;5(3):197-205.

  • 39. van den Brink W Hendriks VM Blanken P Huijsman IA van Ree JM. Medical co-prescription of heroin two randomized controlled trials. Central Committee on the Treatment of Heroin Addicts (CCBH) Utrecht The Netherlands 2002.

  • 40. Wright NM Tompkins CN. Supervised injecting centres. BMJ. 2004;328(7431):100-2.

  • 41. Blanken P Hendriks VM Koeter MW van Ree JM van den Brink W. Matching of treatment-resistant heroin-dependent patients to medical prescription of heroin or oral methadone treatment: results from two randomized controlled trials Cochrane Database Syst Rev. 2003;(4):CD003410.

  • 42. Oviedo-Joekes E March JC Romero M Perea-Milla E. The Andalusian trial on heroin-assisted treatment: a 2 year follow-up. Drug Alcohol Rev. 2010;29(1):75-80.

  • 43. Blanken P Hendriks VM van Ree JM van den Brink W. Central Committee on the Treatment of Heroin Addicts University Medical Centre Utrecht Utrecht The Netherlands. Outcome of long-term heroin-assisted treatment offered to chronic treatment-resistant heroin addicts in the Netherlands 2010.

  • 44. Shetty P. UK Government considers supervised injecting clinics. Lancet. 2008;371(9612):545-6.

  • 45. National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide (Second Edition). NIH Pub Number: 09-4180 Revised: April 2009.

  • 46. McLellan AT Lewis DC O'Brien CP Kleber HD. Drug dependence a chronic medical illness: implications for treatment insurance and outcomes evaluation. JAMA. 2000;284(13):1689-95.

  • 47. Carise D McLellan AT Cacciola J Love M Cook T Bovasso G Lam V. Suggested specifications for a standardized Addiction Severity Index database. J Subst Abuse Treat. 2001;20(3):239-44.

  • 48. Darke S Hall W Wodak A Heather N Ward J. Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: the Opiate Treatment Index. Br J Addict. 1992;87(5):733-42.

  • 49. Kirchmann H Schreiber-Willnow K Seidler KP Strauss B. SCL-90-R symptom profile clusters among inpatients undergoing psychodynamic group psychotherapy: cluster stability associations with clinical characteristics and treatment outcome. Psychopathology. 2011;44(2):71-82.

  • 50. Gandek B Ware JE Aaronson NK Apolone G Bjorner JB Brazier JE Bullinger M Kaasa S Leplege A Prieto L Sullivan M. Cross-validation of Item Selection and Scoring for the SF-12 Health Survey in Nine Countries: Results from the IQOLA Project. J Clin Epidemiology. 1998;51(11):1171-8.

  • 51. Haasen C Verthein U Degkwitz P Berger J Krausz MNaber D. Heroin-assisted treatment for opioid dependence: randomised controlled trial. Br J Psychiatry. 2007;191:55-62.

  • 52. Gerstein DR Harwood HJ. Evaluating recovery services: The California drug and alcohol treatment system (CALDATA): General report. Sacromento: Californai Department of Alcohol and Drug Programs 1994.

  • 53. Gossop M Stewart D Marsden J. Effectiveness of drug and alcohol counseling during methadone treatment: content frequency and duration of counseling and association with substance use outcomes. Addiction. 2006;101:404-412.

  • 54. Perneger TV Giner F del Rio M Mino A. Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments. BMJ. 1998;317(7150):13-8.

  • 55. Ferri M Davoli M Perucci CA. Heroin maintenance for chronic heroin-dependent individuals. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD003410.

  • 56. Consumption Rooms as a Professional Service in Addictions Health: International Conference for the development of guidelines. Guidelines for the operation and use of consumption rooms. 1999. www.adf.org.au/injectingrooms/guidelines.pdf (accessed 11 Nov 2003).

  • 57. Carlson RG. Shooting galleries dope houses and injection doctors: examining the social ecology of HIV risk behaviors among drug injectors in Dayton Ohio. Hum Organ. 2000;59(3): 325.

  • 58. Stoever H. Consumption rooms-a middle ground between health and public order concerns. J Drug Iss. 2002;32:597- 606.

  • 59. European Monitoring Centre for Drugs and Drug Addiction. Annual report on the state of the drugs problem in the European Union and Norway. Luxembourg: EMCDDA 2002.

  • 60. Yamey G. UN condemns Australian plans for “safe injecting rooms”. BMJ. 2000;320:667.

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