Heroin on trial: Systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction

Strang, John; Groshkova, Teodora; Uchtenhagen, Ambros; Brink, Wim van den; Haasen, Christian; Schechter, Martin T.; Lintzeris, Nick; Bell, James; Pirona, Alessandro; Oviedo‐Joekes, Eugenia; Simon, Roland; Metrebian, Nicola

doi:10.1192/bjp.bp.114.149195

Cited by 200 publications

(173 citation statements)

References 53 publications

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“…398,400 Evaluations of the Swiss HAT experience have consistently shown good results in reduction of illicit drug use, crime and mortality linked to the program, 401,402 findings later replicated in other settings. 403 …”

Section: A Better Way For Drug Policy? Learning From Selected Experiementioning

confidence: 99%

Public health and international drug policy

et al. 2016

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Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

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Section: A Better Way For Drug Policy? Learning From Selected Experiementioning

confidence: 99%

Public health and international drug policy

et al. 2016

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“…We value clear recognition, and understanding, of a patient population that requires sustained medication for their chronic condition. Kidd and colleagues [2] describe the work as 'a helpful first step', which is exactly what we intended. Our aim was not to be prescriptive, but to engender further discourse on the role of maintenance across substances.…”

Section: Declaration Of Interestsmentioning

confidence: 85%

“…As a result there are some agents available for opioid dependency which meet the proposed criteria less fully but may still be clinically valuable in specific circumstances. Diamorphine, for example, has developed an evidence base demonstrating clinical effectiveness in specific circumstances which mitigates against their lack of a 'match' to the proposed model [2]. This model must be modified to reflect these variables more clearly.…”

Section: What Matters Is More Than Just the Choice Of Pharmaceutical mentioning

confidence: 99%

“…As noted by Lingford-Hughes [3], long-term maintenance is not employed widely outside the opioids and, to a lesser extent, nicotine. Furthermore, as Kidd and colleagues [2] note, even within opioids the agonist treatment palette remains limited. The clinical reality is that, as argued by Shoptaw [4] and Walter & Soyka [5], abstinence is not always a feasible treatment goal.…”

Section: Declaration Of Interestsmentioning

confidence: 99%

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What matters is more than just the choice of pharmaceutical agent

Kidd

Day²,

Strang³

2016

Addiction

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“…He had entered supervised injectable heroin treatment in April 2014, 10 months prior to the interview, necessitating daily treatment attendance 4. His treatment compliance had led to dramatic health improvements: “I’ve started to cut down on my diamorphine dose and am now down from 230 ml twice daily to a single 200 ml dose once a day.…”

Section: Case Presentationmentioning

confidence: 99%

Heroin overdose resuscitation with naloxone: patient uses own prescribed supply to save the life of a peer

et al. 2015

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Opiate overdose is the primary cause of death among injection-drug users, representing a major public health concern worldwide. Opiate overdose can be reversed through timely administration of naloxone, and users have expressed willingness to carry the antidote for emergency use (take-home naloxone). In November 2014, new WHO guidelines identified that naloxone should be made available to anyone at risk of witnessing an overdose. We present the case of a 46-year-old man in opioid-maintenance treatment who used take-home naloxone to rescue an overdose victim. This is the first- ever account of a patient using dose titration of naloxone to restore respiratory function while minimising the risk of adverse effects. To improve the safety of take-home naloxone, the authors call for clinicians involved in the treatment of opiate users to: prescribe take-home naloxone to all patients; forewarn patients of potential side effects; and instruct patients in naloxone dose titration.

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Heroin on trial: Systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction

Cited by 200 publications

References 53 publications

Public health and international drug policy

Public health and international drug policy

What matters is more than just the choice of pharmaceutical agent

Heroin overdose resuscitation with naloxone: patient uses own prescribed supply to save the life of a peer

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