© 2002 by European Journal of Public Health
Substance Abuse |
Heroin-assisted treatment as a response to the public health problem of opiate dependence
Benedikt Fischer1,2, Jürgen Rehm1,2,3, Maritt Kirst2, Miguel Casas4, Wayne Hall5, Michael Krausz6, Nicky Metrebian7, Jean Reggers8, Ambros Uchtenhagen3, Wim Van Den Brink9 and Jan M. Van Ree91 Department of Public Health Sciences, University of Toronto, Canada 2 Centre for Addiction and Mental Health, Toronto, Canada 3 Addiction Research Institute, Zürich, Switzerland 4 Servicio de Psiquiatria, Hospital Universitari Vall d'Hebron, Barcelona, Spain 5 Institute of Molecular Bioscience, University of Queensland, St. Lucia, Australia 6 Klinik für Psychiatrie und Psychotherapie, Hamburg, Germany 7 Department of Social Science & Medicine, Imperial College School of Medicine, London, UK 8 Department of Psychiatry, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium 9 Central Committee Treatment Heroin Addicts, Utrecht, The Netherlands
Injection drug use (involving the injection of illicit opiates) poses serious public health problems in many countries. Research has indicated that injection drug users are at higher risk for morbidity in the form of HIV/AIDS and Hepatitis B and C, and drug-related mortality, as well as increased criminal activity. Methadone maintenance treatment is the most prominent form of pharmacotherapy treatment for illicit opiate dependence in several countries, and its application varies internationally with respect to treatment regulations and delivery modes. In order to effectively treat those patients who have previously been resistant to methadone maintenance treatment, several countries have been studying and/or considering heroin-assisted treatment as a complementary form of opiate pharmacotherapy treatment. This paper provides an overview of the prevalence of injection drug use and the opiate dependence problem internationally, the current opiate dependence treatment landscape in several countries, and the status of ongoing or planned heroin-assisted treatment trials in Australia, Canada and certain European countries.
Keywords: clinical trials; heroin-assisted treatment; opiate dependence; opiate pharmacotherapy treatment; public health
Received 7 May 2001. Accepted 3 December 2001.
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