Heroin maintenance for chronic heroin-dependent individuals

Ferri, Marica; Davoli, Marina; Perucci, Carlo A.

doi:10.1002/14651858.cd003410.pub3

Cited by 30 publications

(15 citation statements)

References 39 publications

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“…NICE has undertaken several systematic reviews and meta-analyses in these areas, and there are other guidelines and Cochrane reviews available (e.g. Ferri et al, 2011;Knapp et al, 2007;White et al, 2011). There is limited evidence concerning the interaction between these two approaches or whether there is an optimal pharmacological-psychosocial combination.…”

Section: Treatment Aimsmentioning

confidence: 99%

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

Welch²,

et al. 2012

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The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short-and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people. KeywordsSubstance misuse, addiction, guidelines, pharmacotherapy, comorbidity 1 Imperial College London, CNWL NHS Foundation Trust, London, UK 2 Gether NHS Foundation Trust, Gloucester, UK 3 Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UKOther invited participants at the consensus meeting who contributed to the discussion and commented on the guidelines were Drummond C, Farrell M, Gilvarry E, Strang J. John, a user representative, read and commented on the written guidelines. Prof W van den Brink reviewed the written guidelines.

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Section: Treatment Aimsmentioning

confidence: 99%

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

Welch²,

et al. 2012

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“…MMT patients also experience significant difficulty in transitioning onto methadone, run higher risks of overdose, and endure significant negative side effects, all of which result in poor rates of treatment retention (Bourgois, 2000: 185;CPBC, 2013). Many have asked, therefore, why methadone continues to be the dominant treatment modality for heroin addiction when heroin-assisted treatment (HAT)-prescribing pharmaceutical-grade heroin under clinical conditions-has shown consistently better treatment outcomes than MMT alone in every respect, from improving health, social integration, and employment, to decreasing crime and illicit drug use, and even ceasing drug use entirely-all at lower cost to the state (Csete et al, 2010;Ferri et al 2011;Uchtenhagen, 1999). So, why is methadone granted the status of useful 'medication' while heroin is stigmatized as a harmful 'drug' (Agar, 1977;Bourgois, 2000: 169)?…”

Section: Jouissance Drug Use and Drug Policymentioning

confidence: 99%

The libidinal economy of revanchism: Illicit drugs, harm reduction, and the problem of enjoyment

Proudfoot

2017

Progress in Human Geography

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The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details.

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“…To date, the research has demonstrated ample safety margins with no harm attributable to the medically prescribed substitute and remarkable levels of effectiveness regarding different outcome measures (reduction of severity of addiction, criminality levels and streetacquired heroin, social adjustment improve ment, cost-effectiveness and so on). 17,18 Furthermore, OST follows the principle of beneficence as it provides active and specific help to all those individuals whom, at some point in their addiction history, do not feel prepared to give up their addiction. One must remember that part of the success of these therapeutic options is based in the fact that they have been successful in retaining within the health and social services networks, populations of addicts, otherwise hidden populations, out of contact and out of reach.…”

Section: Providing Users With a Substance Like That Which Created Thementioning

confidence: 99%

“…22 The benefits, as detected with meta-analysis, include improvement in retention in treatment and reduction of consumption of illicit drugs plus reduction of criminal activity and improvement of social adjustment. 18 Beyond meta-analysis, findings from individual trials have been conclusive and remain undisputed. However, none of the countries that commissioned such studies have changed their policies despite the research outcomes.…”

Section: Heroin Substitution Therapymentioning

confidence: 99%

The Ethics in Substitution Treatment and Harm Reduction. An Analytical Review

Aceijas

2012

Public Health Rev

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The ethics of opiate substitution treatment (OST) modalities for heroin addiction have been abundantly criticised but also have equally strong supporters. This analytical review addresses three main arguments against such treatments: 1) the social nature of the issue involves a misuse of the medical care; 2) the aim is one of social control (as opposed to a "cure") and therefore is a perversion health care; and 3) prescribing the very substance (or a substitute) that caused the addiction is ethically questionable. Additionally, the generic criticism against the philosophical/ theoretical framework under which they operate, "harm reduction" (HR) as an operational goal of therapy, is also addressed here.A summary review of the history of addiction supports the argument that, indeed, drug addiction "as a problem" was socially created. Equally clear is that one of the aims of OST and all drug-addition treatments is the social control of individual behaviours. However, neither of these two aspects justifies refusal to provide health and social care. OSTs are legitimate therapeutic options because they comply with the four principles of bioethics-autonomy, nonmaleficence, beneficence and justice. The argument that such treatments and the HR approach, in general, align with the principle of consequentialism-the aim justifies the means-and therefore is ethically questionable is a disingenuous criticism. Consequantialism is based in the implicit assumption that harms are accepted to reach certain objectives as the lesser of two evils. OSTs have been extensively proven as to their safety with benefits margins both at the individual (retention, reduction of illicit drug use and better social adjustment) as well as at the population levels (e.g., HIV incidence reduction). Heroin-substitution based treatment is the latest case of moral resistance to provide patients with the most effective option in spite of sound evidence on its effectiveness and safety. As in other cases of spurious resistance to public health and medical innovations, it is only a matter of time and endurance until such treatments are fully integrated among standard therapeutic options for heroin dependent individuals.

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Heroin maintenance for chronic heroin-dependent individuals

Cited by 30 publications

References 39 publications

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

The libidinal economy of revanchism: Illicit drugs, harm reduction, and the problem of enjoyment

The Ethics in Substitution Treatment and Harm Reduction. An Analytical Review

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