SUBSTITUTION THERAPY FOR HEROIN ADDICTION

Abstract

Substitution treatment for heroin addiction, defined here as maintenance prescribing of opioid agonist drugs to opioid dependent subjects, has increased in the last decade. The recent history of substitution treatment in five countries—Canada, the U.K., Australia, Israel, and France—is reviewed. In all five countries, the critical issues around substitution treatment are similar. The first key issue concerns the balance between making treatment accessible and attractive, and minimizing diversion to the black market. The second issue concerns the role of primary health care in delivering MMT. In general, there has been increasing involvement of primary health care, with training and support for practitioners. However, there remains uncertainty and official ambivalence over whether treatment should be restricted to specialist clinics and practitioners, or available through primary care. Most importantly, underlying these issues is the problem of stigma being associated with both addiction, and with substitution treatment. The underlying problem that treatment is often at odds with community values places enormous strains on substitution treatment, and makes the treatment system vulnerable to shifting community support and abrupt, politically-driven changes in policy.

• Methodone
• Heroin
• Buprenorphine
• Substitution treatment

Additional information

Notes on contributors

James Bell

James Bell is a physician specializing in the treatment of drug dependence. He is Director of The Langton Centre, a specialist facility for research into and treatment of people with drug-related problems. His Major research interest is substitution treatment. Dr. Bell has been active in the establishment of a specialist credentialling program for medical practitioners working in Addiction Medicine.

Alain Dru

Alain Dru was with the French Harm Related Reduction Association at the time this paper was written.

Benedikt Fischer

Benedikt Fischer, Ph.D. (Canada), criminologist, scientist, coordinator, Drug Policy Research Group, Centre for Addiction and Mental Health, teaches at the Departments of Public Health Sciences and Criminology at the University of Toronto; researches and published widely in international drug law and policy, harm and social costs of drug use, substitution treatment evaluation and policy, member of the North American Working Group currently drafting a proposal for a North American Heroin Prescription Treatment Trial (NAOMI = North American Opiate Medications Initiative).

Shabtay Levit

S. Levit, M.A. (IL), created and directs methadone treatment programs in Jerusalem. He is chairman and coordinator of the Israel Methadone treatment center. His areas of interest include models of rehabilitation, individuals and systems.

M. Aamer Sarfraz

M. Aamer Sarfraz is a research and clinical psychiatrist. He trained and qualified from the Maudsley and Institute of Psychiatry, London and has taught, researched, and worked at a Consultant Psychiatrist level in Mental Health in different countries. He works and writes for education and social welfare issues/charities on regular basis.