Identifying Europe’s information needs for effective drug policy

Lisbon, 6-8 May 2009

Parallel sessions: Practice

Parallel session A. Treatment and harm reduction, needs for more tailored interventions

Title of the presentation: Heroin prescription – new responses for the hard to treat

Name: Prof. Dr. Christian Haasen
Affiliation/Institution:University of Hamburg
Address:Dept. of Psychiatry, UniversityMedicalCenter Eppendorf, Martini Str. 52, 20246 Hamburg, Germany
e-mail:
Bionote:
Born in Sao Paulo Brazil, educated in Bogota, Colombia, New York & Philadelphia, USA, Munich & Hamburg, Germany, presently Senior Psychiatrist, Director of Centre of Interdisciplinary Addiction Research (ZIS) & Head of Addiction Division at University Medical Center Eppendorf; principal investigator of various clinical studies on addiction treatment, evaluation research on addiction policy and services; main editor of European Addiction Research.
Abstract:
Maintenance treatment (MT) has been found to be effective in reducing health problems and criminality associated to opioid dependence. MT with methadone is considered the “gold standard”. However, a considerable portion of opioid dependent persons treated with methadone MT do not respond sufficiently, showing continued street heroin use, use of other illicit substances, health problems, criminal activity and social marginalization. This has lead to a diversification of substances used for MT, including substances such as buprenorphine, codeine, and slow release morphine, but non-response has remained a problem. This has lead to a debate and subsequent studies on MT with heroin (diamorphine). Studies in five countries – Switzerland, the Netherlands, Spain, Canada and Germany – have been completed, all showing that supervised co-prescription of heroin is feasible, more effective, more cost-effective and probably just as safe as methadone alone leading to sustained improvements in physical and mental health and in social functioning including a substantial reduction in criminal activities. The evidence also suggests that when compared to methadone treatment in the hard-to-treat population, heroin assisted treatment shows better results in the reduction of alcohol and benzodiazepine use. These results suggest that heroin assisted treatment may be an important treatment option.
Related publications:
Haasen C, Verthein U, Degkwitz P, Berger J, Krausz M, Naber D: Heroin-assisted treatment for opioid dependence: a randomised, controlled trial. British Journal of Psychiatry, 2007; 191:55-62
Verthein U, Bonorden-Kleij K, Degkwitz P, Dilg C, Köhler W, Passie T, Soyka M, Tanger S, Vogel M, Haasen C: Long-term effects of heroin-assisted treatment in Germany. Addiction, 2008; 103:960-6
Fischer B, Oviedo-Joekes E, Blanken P, Haasen C, Rehm J, Schechter M, Strang J, van den Brink W: Heroin-Assisted Treatment (HAT) a decade later: A brief update on science and politics. Journal of Urban Health, 2007; 84:552-562
Hartwig C, Haasen C, Reimer J, Garbe W, Lichtermann D, Wüllenweber L, Dilg C: Pregnancy and birth under maintenance treatment with diamorphine (heroin): a case report. European Addiction Research 2008; 14:113-114