Heroin Assisted Treatment
The state of play
July 2010
This briefing paper explores the question of Heroin Assisted Treatment (HAT), examines the growing body of evidence emerging from its clinical use in addiction therapies, and makes recommendations for policy makers.
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The United Nations Office on Drugs and Crime (UNODC) estimates that there are presently between 15.5 and 21.1 million opiate users in the world, the majority of whom are heroin users. There has been a growing awareness of the importance of treatment for this population in recent decades, with Opiate Substitution Therapy (OST) prominent amongst the range of treatment modalities.
While methadone remains the most widely used substitute, clinicians and researchers recognise that there is a significant number of users for whom methadone has proved ineffective. This recognition has driven an expansion in the range of substitution modalities, and, in some parts of the world, clinicians have employed heroin (or, more precisely, diacetylmorphine or diamorphine, its licit, unadulterated pharmaceutical form) in the treatment of opiate addiction. This briefing paper explores the question of Heroin Assisted Treatment (HAT), examines the growing body of evidence emerging from its clinical use in addiction therapies, and makes recommendations for policy makers.
There is now a powerful body of evidence demonstrating consistently that heroin-assisted treatment, delivered in a clinical setting with appropriate safeguards and supports, is a more effective treatment for problematic heroin users than oral methadone, even where this is delivered to optimised standards. HAT is as safe as other forms of OST, and of greater costeffectiveness. Although most of the studies so far undertaken have been relatively short term, those longer term investigations that have been completed point to continuing benefits. Such benefits accrue, moreover, in a population suffering considerably higher levels of mortality and morbidity, and which is more engaged with crime, than the general population, and which has been found very difficult (or impossible) to reach by more standard therapies.
Certainly it seems undeniable that a strong evidence base has been assembled, and while each new trial adds specific further data to it, the time has now come to translate this evidence into practical measures that expand the range of available treatments. In the past the pressure was primarily on science to produce the evidence basis on HAT—the pressure is now on politicians to use the evidence generated in the interest of reducing harms and costs related to the problem of heroin addiction.
