Prescribing heroin: nothing to fear but fear itself?

The contribution of research to Australian policy responses to heroin dependence 1990-2001: a personal retrospection

Periodic public concern about heroin use has been a major driver of Australian drug policy in the four decades since heroin use was first reported. The number of heroin-dependent people in Australia has increased from several hundreds in the late 1960s to around 100,000 by the end of the 1990s. In this paper I do the following: (1) describe collaborative research on heroin dependence that was undertaken between 1991 and 2001 by researchers at the National Drug and Alcohol Research Centre; (2) discuss the contribution that this research may have made to the formulation of policies towards the treatment of heroin dependence during a period when the policy debate crystallized around the issue of whether or not Australia should conduct a controlled trial of heroin prescription; and (3) reflect on the relationships between research and policy-making in the addictions field, specifically on the roles of investigator-initiated and commissioned research, the interface between researchers, funders and policy-makers; and the need to be realistic about the likely impact of research on policy and practice.

Medical Co-Prescription of Heroin to Chronic, Treatment-Resistant Methadone Patients in the Netherlands

This paper begins with a brief description of the epidemiology of heroin addiction in the Netherlands and an overview of the current treatment system, with special emphasis on oral methadone maintenance. It is followed by a short history of the debate over the prescription of heroin to addicted patients. This history reveals that alternatives to methadone have been viewed as essential in the Netherlands since the early 1980s. Earlier experiments with intravenous morphine, intravenous methadone and oral dextromoramide (PalfiumR) were not as successful as had been hoped and precluded their introduction in daily practice. Finally, recent experiences in Switzerland with the medical prescription of heroin facilitated the decision to initiate a scientific study of the medical co-prescription of heroin in the Netherlands. The paper provides a detailed description of the randomized clinical trial regarding the effectiveness of co-prescribed heroin that is now underway in the Netherlands. It concludes with a brief discussion of the likely consequences for future treatment options of different study outcomes.