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New Heroin-Assisted Treatment: Recent Evidence and Current Practices of Supervised Injectable Heroin Treatment in Europe and Beyond

NCJ Number
John Strang; Teodora Groshkova; Nicola Metrebian
Date Published
176 pages
This book examines the use of supervised injectable heroine (SIH) as part of a highly regulated treatment regime which targets a difficult-to-treat group of patients.
This book provides the first state-of-the-art overview of research on using SIH treatment for those who have failed to respond adequately to other approaches. Also examined is the clinical management issues necessary to ensure that this therapeutic option can be delivered in a manner that avoids the obvious risks associated with such an intervention. Results suggest that SIH has emerged as a potentially important intensive second-line treatment for entrenched heroin addicts for whom previous treatments such as oral methadone maintenance treatment (MMT) or residential rehabilitation have produced few benefits. The prescription of substitution drugs, such as methadone and buprenorphine, has become a mainstream, first-line treatment for opioid dependence, with around 700 000 of Europe's 1.3 million problem opioid users receiving substitution treatment today. But a small minority of entrenched opioid users repeatedly fails to respond to interventions of this kind. Findings from international trials now suggest that the supervised use of medicinal heroin can be an effective second-line treatment for this small, and previously unresponsive, group. This report describes the historical overview of SIH, including the international policy and legislation regarding this treatment, and examines the research evidence and clinical and policy experience with this new treatment. Provided are data from a series of well-designed, randomized clinical trials from Europe and Canada, and steadily accumulating clinical experience of the development and provision of SIH. Tables, figures, references, bibliography, and glossary