Dutch
to
Consider
Prescription
Heroin
for
Hard
Cases,
Study
Results
Lay
Groundwork
for
Move
2/22/02
The Dutch Health Ministry will recommend to parliament that combination heroin-methadone maintenance be introduced as part of Dutch addiction care, according to a report last Saturday in the British Medical Journal. The recommendation comes on the heels of the release of two Health Ministry trials that suggest heroin-methadone maintenance has greater health benefits than methadone maintenance alone for heroin users for whom no other medical treatment has been effective. The number of people who could be prescribed heroin and methadone could be as high as 2,000 of Holland's estimated 25,000 heroin addicts. The heroin-methadone maintenance trials were commissioned by the Dutch Central Committee on the Treatment of Heroin Addicts, which was set up by the Dutch Health Ministry in 1996 to study the effects of heroin prescriptions for "chronic, therapy-resistant addicts." The trials involved 549 patients in six cities between 1998 and 2001, with patients in one group receiving heroin and methadone for six or 12 months, while patients in a control group received only methadone. Patients prescribed both drugs experienced 23-25% more "clinically relevant improvements" than patients receiving methadone alone. Improvements cited by the study included "better social contacts, less criminality, and less use of cocaine." A follow-up trial found that such improvements vanished quickly within weeks of ending heroin-methadone prescriptions. The trials also found that heroin can be safely prescribed. The studies reported three patient deaths during the trials, which included 140,000 doses of heroin. That is less than half the death rate in methadone maintenance programs, the researchers found. The committee on heroin addiction now recommends that heroin-methadone prescription be part of the Dutch pharmacopeia, that heroin be registered as a medicine, and that a quality control system be developed for prescribing the drug. According to the British Medical Journal, Dutch Health Minister Els Borst will carry that recommendation to parliament, which is expected to approve the measure. (Visit http://www.ccbh.nlto access the full text of the studies online.)
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