What are the health benefits of heroin assisted treatment for entrenched heroin addiction?

 

Abstract: there have been a number of clinical trials conducted which haveaimed to assess the effectiveness of heroin assisted treatment. This paper explores the outcomes of these in relation to any reported health benefits.

Keywords: heroin assisted treatment, health benefits, heroin addiction.

 

Introduction. Heroin addiction is described as a complex, chronic re-lapsing disease, which is characterized by physical dependence and the users’ inability to exercise self-control, and abstain once addiction has taken hold, despite any harmful consequences (National Institute on Drug Abuse, 2016).

 

Heroin assisted treatment (HAT) is the process of prescribing medical grade heroin, such as dialectymorphine (Oviededo-Joekes et al., 2009, 777) and diamorphine (Verthein et al., 2008, 1) to a person addicted to heroin in the place of illicit heroin, which they inject themselves with clean equipment, un-der medical supervision (Nutt, 2012, 164).

 

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There have been a number of clinical trials conducted which have aimed to assess the effectiveness of heroin assisted treatment (EMCDDA, 2012).

 

Method. Arksey and O’Malley (2007, 8–12) designed a methodological framework for scoping reviews, to ensure the methods used are conducted in stages, and in a rigorous and transparent way. This framework consists of five stages:

 

Identifying the research question: as this guides the way that a searchstrategy is built – What are the health benefits of Heroin Assisted Treatment for entrenched heroin addiction?

Identifying relevant studies: examines the range of studies and re-views available for answering the research question – Initial search produced 1247 articles.

Study selection: allows the search to eliminate irrelevant studies bynarrowing the search parameters – databases, search terms and inclu-sion/exclusion criteria applied, abstracts screened which reduced articles to 11.

Charting data: a technique for synthesizing and interpreting data bysorting material according to key themes and issues – 4 main themes identi-fied.

Collating, summarizing and reporting the results: identifying themes,comparing results, identifying contradictory evidence and identifying any gaps in literature – discussed in the results section of this paper.

Results and Discussion

 

Physical Health. Ten out of eleven studies reported on physical health and of these, 8 found statistically significant improvements using a range of measurement tools which included the severity of risky behaviors. Reducing these risks through HAT not only reduces the risk of injury and disease to the individual, but also reduces the risk of spreading blood borne viruses which in itself is a public health issue (Public Health England, 2017).

 

Serious Adverse Events. Equally, the risks associated with HAT treat-ment itself became apparent as four studies reported on serious adverse events. Out of a combined 246 serious adverse events, 5 resulted in death. All 5 fatali-ties were prescribed a higher mean daily dose (442mg) of medical grade hero-in and therefore dosage needs to be considered if this treatment is to be used.

 

Mental Health. All of the studies reported on mental health, with nine of the eleven observing significant improvements. This is an important finding as mental health problems feature heavily amongst people who have an addic-tion to heroin (Nutt, 2012, 162–163). Results from these studies suggest HAT

 

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has allowed the participants to address their mental health issues (Verthein et al., 2008).

 

Illicit Drug Use. Ten out of the eleven studies reported on illicit drug use whilst participants were involved in the studies. Out of the nine studies who tested for use of illicit heroin, eight of these reported a significant de-crease. The results from the studies demonstrates that providing a heroin user, who has previously failed in traditional forms of treatment, with HAT can help to reduce the urges and cravings to seek illicit heroin (Marks, 1996).

 

Treatment Retention. Treatment retention is the foundation of recovery (Bart, 2012, 207). Nine of out the eleven studies reported on retention in treatment, with all studies reporting at least 50% retention rate at 12 months and if compared to a methadone control group, this was higher. Retaining peo-ple in treatment provides the best opportunity for recovery, as they are able to have regular contact with medical practitioners and support workers, this al-lowing them to have access to harm-reduction support and psychosocial inter-ventions (Booth et al., 2004, 180).

 

Limitations of the Study. The study only reviewed eleven papers on the health benefits of heroin assisted treatment using only 4 databases, search terms and published research. A full systematic review would be beneficial to overcome these limitations.

 

Conclusion. All of these findings are an important step forward in terms of harm reduction, attracting people into treatment, and addressing a public health problem (Fischer, 2002, 233-234).

 

This type of model is currently being trialed in Glasgow (Tweed et al., 2016, 29- 30) and plans for a pilot in Durham (Siddique, 2017, 1). These new pilot programmes present a good opportunity to analyze the practical applica-tion of HAT in ‘real life’ situations in the UK.

 

Recommendations:

 

A full systematic review to provide a complete and comprehensive search of relevant literature.

A full evaluation of the practical application of HAT in Glasgow and Durham, with a recommendation that these two programmes also use the same scales and tests, so a direct comparison and evaluation can take place to get a better understanding of HAT in practice.

 

 

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Literature

 

Arksey H., O’Malley L. Scoping studies: Towards a methodologicalframework // International Journal of Social Research Methodology. 2005.

 

8(1). P.19–32.

 

Bart G. Maintenance Medication for Opiate Addiction: The Founda-tion of Recovery // Journal of Addictive Diseases. 2012. № 31 (3). P. 207– 225.

Booth R., Corsi K., Mikulich-Gilbertson S. Factors associated withmethadone maintenance treatment retention among street-recruited injection drug users // Drug and Alcohol Dependence. 2004. № 74 (2). P.177–185.

EMCDDA. EMCDDA report presents latest evidence on heroin-assisted treatment for hard-to-treat opioid users. URL: http://www.emcdda.europa.eu/news/2012/1 (аccessed: 07.12.2016).

 

Fischer B. Heroin-assisted treatment as a response to the public healthproblem of opiate dependence // The European Journal of Public Health. 2002. № 12 (3). P. 228–234.

Marks J. Preventing drug Mis-use. URL:http://www.priory.com/psych/marx.htm (аccessed: 03.01.2017).

National Institute on Drug Abuse. Understanding drug use and addic-tion. URL: https://www.drugabuse.gov/publications/drugfacts/ understanding-drug-use-addiction (аccessed: 07.12.2016).

Nutt D. Drugs-without the hot air: Minimising the harms of legal andillegal drugs. Cambridge, 2012.

Oviedo-Joekes E., Brissette S., Marsh D. Diacetylmorphine versusMethadone for the Treatment of Opioid Addiction // New England Journal of Medicine. 2009. № 361 (8). P.777–786.

Public Health England. National Treatment Agency for Substance Misuse – Preventing the spread of blood-borne viruses. URL: http://www.nta.nhs.uk/bbv.aspx (аccessed: 16.03.2017).

Siddique H. Durham police will give addicts heroin to inject in

 

'shooting galleries'. The Guardian. URL: https://www.theguardian.com/society/2017/mar/05/durham-police-heroin-addicts-treatment-shooting-galleries (аccessed: 18.03.2017).

 

Tweed E., Craighton E., Rodgers M. Taking Away the Chaos. Scot-tish Justice Matters. URL: http://scottishjusticematters.com/wp-content/uploads/Taking-away-the-chaos-from-SJM_4-3_November2016.pdf (аccessed: 16.03.2017).

 

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Verthein U., Bonorden-Kleij K., Degkwitz P. Long-term effects ofheroin-assisted treatment in Germany // Addiction. 2008 № 103(6). P. 960– 966.

 

 

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