Prescribing heroin (diamorphine) to treat addicts was first attempted in Britain in the 1920s. The idea behind heroin maintenance treatment (HMT), is that addicts who have not responded to other forms of treatment would function better if they were kept on pure heroin prescribed by a doctor. Proponents of HTM argue that addicts who receive it can reduce their intake of illegal street heroin, function better in society, and not be inclined to commit crimes in order to get their drugs.
Britain scaled back its prescription heroin program considerably between the 1960s through the 1980s, due to pressure from the US and lack of clinical trials. In 1994 Switzerland started large-scale trials to determine if heroin maintenance could help with their heroin problem. Satisfied with the results Switzerland started a HMT program, followed shortly after by Germany and the Netherlands. Critics of HMT look at it as a harm reduction strategy that could create the perception that behaviors, such as using illicit drugs, can be partaken in safely. They feel that maintaining destructive, addictive, and compulsive behaviors in users sends the wrong message to the public.
The Two Modes of Heroin Maintenance Treatments
HMT is the distribution of high-grade pure diamorphine to addicts as prescribed and monitored by a doctor. There are two ways to implement this treatment, both with their own unique drawbacks.
1. HMT by prescription.
In the British system patients are given weekly prescriptions of heroin. Like any prescribed medication they pick up their weekly supply all at once and have their doses at their homes. This provides them with freedom from regular clinic visits, which makes managing a job easier.
The drawback of this method is that while they get a better product cheaper than on the street, they also can benefit financially from selling part of their prescription. Critics of prescription HMT state that this method creates more drug dealers, and may encourage some people to get into the programs for financial reasons.
2. HMT at a treatment center (Clinic).
The second mode of distribution of heroin maintenance is daily visits to a clinic. This stops the diversion of prescribed heroin to the black market, and these clinics operate much like methadone maintenance programs.
John Kaplan wrote in his paper, “The Practical Problems of Heroin Maintenance”, about the problems associated with this on-the-premise system. Unlike methadone, heroin has a short half-life, which means that the chronic user will start to notice the drug wearing off in 4-6 hours. If HMT is viewed as social rehabilitation designed to get users back to work, we can see that going to the clinic every 6 hours would be problematic.
Harm Reduction VS. Rehabilitation
Although some studies view HMT as a viable way to help addicts who have failed in other forms of treatment, it is more beneficial as harm reduction than it is a solution. Long-term opioid use presents problems for the user, as outlined in this article by Richard Juman. The author points out that even in cases of chronic pain, the cons of opioid use far outweigh the pros.
In cases of doctor prescribed heroin the user is said to do well because they are given their drug of choice, the same drug that they have developed a tolerance for, and dependence on. It is supposed to be more effective than methadone maintenance for this reason, but what is to keep these addicts from increasing their dosage when they no longer feel the euphoric effects of the drug?
Drug education, quality rehabilitation, and abstinence would appear to provide a much higher quality of life for addicts rather than a lifetime of opioid dependence.