Prescribing heroin to chronic addicts may be politically sensitive, but it is more effective than the substitute methadone at keeping drug abusers in treatment programmes, British scientists said.
Researchers who studied different ways of treating heroin addiction said their findings could provide an answer to helping the 5 to 10% of the most severe addicts who fail to stick to conventional addiction treatment programmes.
"Our scientific understanding about how to treat people with severe heroin addiction has taken an important step forward," said John Strang, head of the National Addiction Centre at King's College London, who led the study.
"(This) study shows that previously unresponsive patients can achieve major reductions in their use of street heroin."
What the study showed
Strang's study, published in The Lancet medical journal, followed 127 heroin addicts who were assigned to various treatment programmes. After 26 weeks, 80% of addicts were still in treatment - 81% on injectable methadone, 88 percent on injectable heroin, and 69% on oral methadone.
The proportions of patients who tested negative for street heroin more than half of the time were highest in the injectable heroin group (66%) followed by injectable methadone (30%) and oral methadone (19%).
Street heroin addicts are at high risk of diseases like the human immunodeficiency virus (HIV) that causes Aids because they share needles or use dirty ones to inject the drug.
Many of Britain's 300 000 heroin users resort to committing crimes such as theft to fund their habit.
A study in Canada published last August showed that the cost of heroin treatment is less than $10 000 per year, while the estimated cost to society of a drug addict who fails to stay in treatment is more than $50 ,000 a year - including things like emergency medical care, courts, police and jail.
Strang said his and previous studies gave governments "robust evidence" to support offering injectable medical heroin to some addicts.
Other experts, commenting on the study, called on politicians to recognise the evidence in favour of prescribing heroin for difficult-to-treat addicts and cast aside the stigma associated with it.
"History tells us that availability of heroin prescription can be dictated more by special interests and politics than evidence," said Thomas Kerr of the British Columbia Centre for Excellence in HIV/AIDS in Vancouver, Canada.
He pointed to various situations in Australia, Switzerland and other countries where heroin trials have been halted or existing heroin support programmes have been threatened by political fears that they might be "sending the wrong message".
"In the era of evidence-based decision making, moving forward will probably need those embroiled in this debate to cast aside the stigma associated with heroin prescription," Kerr wrote in a commentary. - (AP, May 2010)