To Help Heroin Addicts, Give Them… Prescription Heroin?

By Eliza Strickland | August 20, 2009 1:30 pm

harm reduction kitResearchers have found a way to reduce the ill-effects of heroin addiction and to generally keep the addicts out of trouble, but there’s a catch: The solution is to give the addicts injections of a pure form of pharmaceutical heroin twice a day. In a fascinating new study, Canadian researchers found that addicts who received the prescription heroin were more likely to stay in treatment than those given methadone, the commonly prescribed opioid that manages heroin cravings without providing the high. Experts say lengthy treatment is often needed to treat other diseases as well as provide counseling to reverse criminal behavior and otherwise stabilize addicts’ lives and improve the chances that they will stop using heroin [The Wall Street Journal].

The study enrolled 226 heroin addicts who had been using the drug for at least five years, and who had failed to stick with a methadone-treatment program at least once. Half the subjects came to the clinic to receive shots of diacetylmorphine—pure heroin—while the other half received standard methadone treatment. After one year, 88% of those in the diacetylmorphine group were still in treatment, compared with 54% in the methadone group [Los Angeles Times]. The test subjects who received heroin were also more likely to reduce their criminal behavior and their drug use outside the clinic, according to the study published in the New England Journal of Medicine.

The study did report some serious “adverse events,” which is little surprise when dealing with dangerous drugs and a population that doesn’t always comply with the doctor’s orders. One patient from the methadone group died of an opioid overdose during the 12-month trial. But overall, serious adverse events were more than 2½ times more common among the [diacetylmorphine] group. Sixteen of those participants experienced a life-threatening seizure or overdose; all received prompt treatment at their clinic and recovered [Los Angeles Times]. In almost all those cases, the patients later admitted that they had used other substances.

The idea of distributing heroin to addicts remains extremely controversial, but in parts of Europe and Canada policy-makers have gently proposed harm reduction. The idea is that, even if people can’t get clean, they could still get help to live healthier and more productive lives, avoiding some of the worst health risks of heroin — like HIV and hepatitis C, which are both spread through dirty needles — and eliminating a major reason for crimes like theft and prostitution, used to fund drug habits [Time]. But in the United States, where heroin is classified as an illegal drug with no medical uses, such policies are very unlikely to take hold. In fact, U.S. researchers who had hoped to help with the Canadian study had to drop out because they couldn’t get approval from the U.S. Drug Enforcement Agency and the Food and Drug Administration.

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Image:  flickr / Todd Huffman

CATEGORIZED UNDER: Health & Medicine, Mind & Brain
  • Sigal Adini

    Legally giving people drugs has consistently failed in helping people overcome addiction. Replacing one drug for another is not treatment and there are many successful programs that don’t use medications in treatment. I would be curious to know who funded the study mentioned in this article. Harm minimization assumes that drug addiction cannot be overcome. That false premise has resulted in more harm than good.

  • John Wilkins

    Wasn’t this done in Manchester back in the 1970s with great effect?

  • Dave Johnson

    So someone has positive results stabilizing the lives of heroin addicts and the “Sigals” of the world say “No!” Sigal, you make the comment that “there are many successful programs”. Give us some statistics. How “successful” are these programs? What percentage of heroin addicts are drug free after 5 years in these programs that you fail to identify. The bottom line is that all drugs – just like nicotine and alcohol – should be legal and controlled by government. In a country like the United States of America, where the individual is king, it seems ludicrous to me that the governemnt interferes in lifestyle choices and then makes criminals of people for making those choices. Help, don’t destroy.

  • gepinniw

    Harm reduction works. So it stands to reason that it’ll never fly in the good ol’ U.S. of A. In America these days, only dumb policies like “The War on Drugs (TM)” are allowed.

  • Brian

    My opinion is that this is a hard problem. No one solution is going to satisfy everyone, ever.

    When I look at addiction at the societal level, the striking thing is that it stubbornly persists, no matter what we do about it. Ban the drugs, make it illegal, have education programs, make addicts pariahs. Some do it anyway.

    The thing I am concerned about is that addicts can be a major entry point for disease into the general (non-addict) population. Oh, and crime is ramant in the areas addicts frequent, and that affects us all too. One big step up the criminal enterprise, drug peddling attracts organized crime like flies to honey.

  • Frank

    Conservatives that bemoan socialism have no qualms about putting almost 2 million people through our legal system in America, funded by our taxes. We have to look at facts, not be led by our fears. “Just say no” was a huge failure, yet pundits still call it a success. Treatment costs less, and is more effective than incarceration when dealing with drug abusers.
    Also, if the punishment should fit the crime, what do you do to deserve getting thrown into Californias illegally overcrowded prison system? A federal review panel said there is no way to prevent or monitor assaults, including rape. Atrocious health care, no where to sleep, and no treatment given. No wonder recidivism is over 70% in some populations.

  • Barry Johnstone

    What would happen if ALL recreational chemicals were made legal? I suspect (but don’t know) that the relatively small % of drug addicts at any one time would remain about the same,then free choice becomes an actual reality – which is what various societies and govenments have been banging on about.

  • http://none Lesley

    I have never tried heroin nor have I ever supported anyone that has. I have had more than my share of chaotic tramatic experiences within the last several years. I know what is what in this world, and I know how I need to live to be happy. However, there are a great number of people that will not allow me to live how and where I need to live. All my money making abilities have been shot down everytime I try. I have gotten to the point of hating people that will not help me. I went from owning my own home free and clear at a young age to complete poverty raising two children on 400 dollars per month. I don’t believe in free rides, and therefore I don’t believe in any government enitity that wants to give someone something for nothing.
    I suffered a near fatal vehicle accident about 10 years ago, I had multiple head trauma and a broken back in 5 places. I can still walk and I am more intelligent than I ever was, but I still cannot get out of this financial situation which has caused me to hate some members of my family and most of the people I used to have strong relationships with.
    I remember the near fatal vehicle accident vividly, the only way I do not dream is when i take sleeping pills.

    I don’t want my memory erased because of fear of anything, I want my memory erased because of the extreme hatred I have for human beings as a result of all that has happened to me in the past 10 years. I think if my memory were completely wiped out, I could do the 9-5 jobs that regular people do without complaint and get on with my life. If I do not find a doctor that will fill me a life long perscription for this memory erasing drug, I am almost certain I could kill the person responsible for putting me and my two children into this terrible situation.

    Please e-mail a list of doctors near Chambersburg PA that will prescribe me this drug as soon as possible, I do not want to end up in jail because someone was really stupid and messed up my life without a reason.

    Thank you

  • Joel

    > Legally giving people drugs has consistently failed in helping people overcome addiction.

    > Replacing one drug for another is not treatment

    > and there are many successful programs that don’t use medications in treatment.

    > I would be curious to know who funded the study mentioned in this article.
    The Canadian Institutes of Health Research.

    > Harm minimization assumes that drug addiction cannot be overcome.

    > That false premise has resulted in more harm than good.

    Sigal, this is a science blog. We prefer finding solutions to ignorance here.

  • http://usi Chad

    Sigal… “Harm minimization assumes that drug addiction cannot be overcome.” I don’t believe harm reduction programs assume that drug addiction cannot be overcome, but the statistics prove that 90% of people will fail at abstinence when dealing with opioid addiction. I think there is huge disconnect in the addiction field because many of the clinical staff are in recovery and they countertransfer all of their beliefs and ideals onto clients and disregard medical facts and this usually results in conflict with staff. You have to ask yourself if someone can get their family, job, and other areas in their life on track with the use of medication… why not. We have to move forward instead of seeing people come into treatment, fill them with aa/na and expect them to succeed. We have other tools that should be combined with traditional therapies. To improve function and quality of life is the root of all medical therapies not to mention the practice of general medicine is harm reduction and if addiction is a disease, it should be treated as one.

  • Andy

    I am a heroin addict. I was a classical mathematics major at a northeastern state university specializing in encryption theory until i lost everything to my addiction. Because of my felony record (all non-violent drug offences) i will probably never have any kind of meaningful career. I have been through almost every treatment from aa to maintenance programs. I just lost my job in telemarketing for a failed drug test although i don’t go to work high. If this is a disease why shouldn’t we medicate patients legally just like we do for diabetic?

  • Courtney

    Having heroin addicts taking heroin to live ‘normal lives’ is ludicrus. I am a heroin addict, I’ve been clean for a little over 9 months. The only way to live a healthy normal life is to go to detox and go on suboxone. It’s worked for me and many other addicts as well. Substitution from one drug to another does not work.

  • Kyle

    Courtney, going on suboxone is substitution from one drug to another…and it works. I’m a heroin addict currently on suboxone maintenance and have been for 5 months. I haven’t used heroin once since i began the treatment. The suboxone does work well but i still have terrible cravings. The cravings are sometimes so overwhelming but i haven’t given in and i don’t plan on ever doing so. If i could have just gotten a perscription to heroin…that would be great. You can live a productive life taking a drug everyday, if you have a legal steady supply, that is. The thing that tears peoples lives apart when it comes to heroin addiction is the fact that it is expensive and illegal. You will go broke/go to jail eventually. Once you have become addicted to opiods, you will always crave the drug. its absolutly terrible and a horrible thing to have to live with. It disgusts me that governments throw addicts in jail for simple drug possession. People don’t realize that opiod dependence is a disease, and it’s one that never goes away. You can relapse any time. When i was in rehab i met a guy who had been clean for 17 years and relapsed. He was a normal, productive person with a wife and kids. If there was a program where he could just get a perscription for his drug, his life wouldn’t have ended up screwed up like it was when he entered treatment. It’s hard for people who have never done drugs to understand. Most people are very ignorant about the whole thing and they act like people who are addicted to drugs are just stupid and should be able to just stop so easily because they don’t understand what it is like. You can’t understand what it’s like unless you have gone through it yourself. After becoming addicted to heroin every time i have gotten clean i have felt like something was missing. You feel like you are not whole. It is hard to explain but it is true. A large amount of people who get addicted to heroin can never successfully quit. This leads to terrible amounts of despair and heartbreak in their lives…it’s really terrible that people have to go through such hell…if the drug was just legal, or if an addict could just be perscribed, this would not happen. Unfortunatly ignorance is very rampant in America, so I’m sure no useful action will ever be taken to correct this problem. Drug rehab programs are EXTREMELY unsuccessful. 9/10 people who go to rehab start usings again, so there goes your argument sigal. You are exactly the ignorant person i am talking about. Legally giving people drugs has consistently failed? Do you have any data to back that up? No….because there isn’t any. If people could legally get drugs the numbers for people infected with hepatitis C would be more than cut IN HALF! and AIDS would probably be greatly reduced. I could keep going on, but it’s late, and I’m going to bed.

  • joanne

    kyle, i come from england and i completly hand on heart agree wth you. i ve struggled and battled heroin addiction on and off for 7 years. im currently on suboxone and i work hard and am a ethical person, not your usual stereo typical scum that most people would have you belive a SCAG HEAD is. But the cravings will always be there and my struggles and problems are magnified because off this everyday. people need to remember NOBODY wants to be a heroin addict its definatly nothing to aspire to, but once your in the clutches for what ever reason nobody can understand the way it conntrols your life from day one . If i was able to have this on a daily basis without the social problems that it produces i would be able to get on with my life as i should and i toatly relate to your sentance of ” something always missing”

  • shannon

    opiate addicts should be given heroin….its the best drug with the shortest half life(making it the easisest to withdraw from). It is no accident that the drug of choice in the medical community for heroin addiction is methadone, bup and suboxone, each with incredibly long half lives, making it almost impossible to detox from. And of course that is exactly what Big Pharma wants….an addict population enslaved to their pharmaceuticals that make them billions. Heroin cannot be patented, so there would be no profit for big pharma. thats why they are fighting so hard to keep Ibogaine illegal and not available for addicts who could escape their addictions pretty easily by using ibogaine once or twice. pretty sad state of affairs. This is also about moralistic judgements. People who are addcited to illegal drugs are SCUM while alcoholics are FINE. Great rational thinking there! A needle is “disgusting” while a “bottle” is acceptable. People are crazy. Americans think that they are so free. What a laugh! They are even more so b ecause of their illusion that they are somehow free. Can you believe that some government can tell us what we can eat or drink and that we can be sent to jail for life for eating or drinking something that we are told can be bad, dangerous , or make us feel good?bad? The whole mess is becoming more and more ridiculous. Sometime in the future our children will be saying ” did that really happen”?

  • shannon

    yes courtenay, your detox and susequent legal addiction to sub is just that ….a drug substitution. When heroin was first developed it was touted as the miracle ‘cure’ for morphine addiction, which is was…if you want to look at it in a drug substitution way. Your new drug “sub” is at least 10 x more addcitive that heroin. Try to stop and you’ll quickly see what i mean. Also when people do an interupter treatment with ibogaine, they need to switch from sub to a short acting opiate like morphine or heroin for several weeks before they attempt the interuppter therapy. The only positive point to sub or methadone is that it is legal therefor you don’t have the [problem about getting the drug. The same thing would hold true if heroin was legalised. Heroin is by far the choice of drug to use for maintenence therapy.

  • vicki

    No one speaks about the crime that is associated with the distribution of illegal drugs. Legalizing the drugs and using prescriptions for it should remove much of the criminal element as well as improve the lives of addicts by keeping them healthier. Its a win win for communities who have been destroyed by drug trafficking. Just take a look at what is going on with Mexico with drug smuggling. Its also good for the drug users as they are healthier. Put a tax on the drug and use the money to pay for rehab programs.

  • Scott

    Shannon is really on to something there with Big Pharma and their efforts to stifle treatments that they cannot patent and control. Recreational chemicals as well as myriads of effective herbal and natural treatments are routinely attacked *because they work*, or because they are really no where near as dangerous as they would like you to believe.

    the most dangerous thing about illegal drugs? The fact that they are illegal.

  • j davis

    No matter how successful European harm reduction programs are don’t look for the US to adopt humane policies. This is a nation that thinks nothing of sending its young halfway around the globe to slaughter other human beings but looks on drug use and some kind of ‘moral’ failing. The US is populated by and large by idiots who don’t want to be confused by facts. Paramilitary drug raids by rogue government agencies are the norm rather than the exception and millions of totally non violent drug ‘offenders’ are jailed every year for having what most reputable medical experts say is a didease. I’m surprised they don’t jail diabetics and those with cancer too.

  • Andi

    Its funny…in the UK(England) alot of addicts dont get sent to prison, even if caught with single wraps of brown or white…generally get fines and sometimes just cautioned (i know this for fact).(unless u have a few convictions already) America they arrest and send to prison more addicts than dealers.—-but there are more drugs on the streets of America, like Percocet, Oxy and Vicodin….pilss u dont see on the black market over here…never….
    Most people that get opiate addicts in England are addicted to prescription pills like DF’s or Morphine or are addicted to Heroin or Methadone.
    Considering in England we have some of the best medical research in the world, the way harm reduction is used over here must be a good thing.
    Today is my first day without methadone for 6 years. Overall Ive had an 8 year habit, Im now 26.
    I have been to rehab, been to all sorts of maintenance clinics and now have moved away from the city, to a small town, where they bend the rules to help people come off and sort their lives out without having to go to rehab, rehab IS NOT for everyone….in fact in this country there is only a 6% non relapse percentage after detox/rehab…that means 94% of the people that go to a proper rehab, do not stay abstinent afterwards…(abstinance is not using at all, not once!!)
    I do understand alot of the concern about certain ‘projects’…well for those that dont want to be councelled by ex-junkies, go to a clinic or phone your local Drug Action Team..they can give you a list of doctors surgery that do shared care—i see a doctor and CPN-Community Psychiatric Nure(but she is also a drug specialist-u have to see the CPN to get ur script).
    These are medical professionals…compared to the schemes where u go see a drugs worker(normally an ex or current(hidden)addict) and they sign a sheet of paper so a normal doctor can give u a script…..going where i am is alot better.
    All methadone scripting is free here on the NHS, unless you go to private healthcare.

    I done this—moved out the city— after repeatedly being given a ‘maintenance’ scrpit because they cant be bothered to do reductions in the London Clinics, as they r too busy.
    For those in the USA who dont understand what we have here…..
    Our first point of call after getting a drug habit is a walk-in drug centre, in these places you have nurses to look at your injection wounds, have something to eat, get free condoms and needle packs, get your name on the list for rehab, get you to a scripting service, get you into housing.
    NO-ONE can say these are bad places, for anyone who has had a chronic habit, you will know when you want to use, and you will 99% of that time, so if theres nothing clean, an old one(needle) is used. Thats what the americans dont get, they access centres make admitting habit alot easier and everyday they are saving peoples lives.
    Alot of these places dont want to give out methadone, but its the cheapest opiate choice, even tho there are guidlines set in place to give people others like Dihydrocodeine, Morphine Sulphate Pills, Liquid Heroin…all short-release opiates, compared to Methadone that is more addictive and alot harder to come off.
    As I have shown so much enthusiasm I have been given a few opiate pills and a 3 week Dihydro script, to cover the methadone coming out my body. By then you only have to cluck off a short release DF which can be reduced so slowly that u dont feel it at all.
    Dont you ‘IGNORANT’ people think that if it was that easy, we’d all be bloody clean by now!!!
    Most the people that have left stupid messages, either have never had a habit or live in those stupid states in America, where they give you 6months in prison just for carrying a needle…..its ridiculous.
    NOONE wants to be an addict, even when you’re using……
    The USA view of things woule be right, kind of, if there werent so many addicts and the world wasnt flooded with this stuff……I live in a very small town now and there are at least 3 smack dealers, when i lived in London, there were probably 5 dealers per every High Street, or more….so its everywhere, its like making smoking illegal and arresting people for carrying rizzla….
    Yes not as serious, but very similar. People could say smoking destroys people and the planet, my uncle died within a week of gettin pneumonia, because he was a heavy smoker. OVS. x
    Anyways Im getting tired, guess the body needs to sleep more even when reducing slowly….i went from 40ml-20ml just like that and done a week on 20, i am nowgonna try these pills, am allowed up to 15ml on top if necessary, cutting it by 1ml till nothing……
    Heres hoping, Ill let u lot know how it goes…..
    For people that have such strong vies against drugs….dont come on drugs forums —–

  • Nathan

    I am a recovering heroin addict. Alot of things failed for me, methadone, rehab, and trying to cut back. The only thing that worked was suboxone. I was on it for 3 years starting at 8mg and worked my way down to 1mg and dropped off. The physical sick only lasted 3 punk ass days and it just made my back hurt. I had to force myself to go do stuff like cut grass but I tell you what, keeping busy and bustin ass in the yard made it feel better almost instantly. 4th day I physically was alright. I just couldn’t get sleep for nothing. That was 2 1/2 weeks ago. The last week I started sleeping 3-5 hours and I can feel myself get better. Motivation comes in spurts and it’s kind of a bitch but everyday I feel better and get a little more sleep than the day before. I used to be scared that once I got off the suboxone I’d go back to my addict way of thinking, but haven’t had a craving since and still don’t. Everyone is different and is going to react to different treatments in different ways. I say do what helps the addict recover.

  • Drug Abuse Stories

    Please connect with me if you can help a real life drug addict.

  • jusa

    maybe try Ibogaine? It is reported to take away withdrawal symptons off the bat.

  • james

    The U.S. will never do anythimg to help heroin addicts doing so would cut down the money supply generated by prisons. Prisons are big business and the powers that be want to keep it that way.The U.S. military is guarding the Afgan poppy fields there is more heroin being produced now than ever before do you really think they are going to let BILLIONS of dollars just slip through their greedy hands. The U.S. is a discrace sending young people all over the world to kill and be killed in the name of freedom meanwhile fighting a so called war on drugs the same drugs that they are helping flood the streets. How long will this [bleep] go on. The U.S. is bound to fall I belive sooner than later.

  • james

    By the way I have been a heroin addict for over 20 years and I can never get more than a year of sobrity at a time

  • Revia?

    Kinda torn on this… Seems anything is worth trying when fighting addictions but perhaps a more global initiative is needed, including going to the root of the evil?

  • cqwalker1

    Give an addict what he needs a real Heroin addict dosen’t even get high off the stuff they need it just to feel normal thats why a fix is called a fix. It fixes your sickness and being sick on heroin withdraw is like having the ebola virus pretty close. Who would risk everything and go thru everything a Heroin addictt does if they could just quit. A real Heroin addict dosen’t want to be an addict they have to thats why its called addiction it is what it is.Just give them what they need to live a productive life no we force them to be criminals . We send them to treatment that fails most everything fails we set them up for failure time and time again oh we can give you methadone or suboxin why substitute ……. give them what they need and have a nice day.


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