Just recently, David Raynes was telling us about the failures of the British programs in heroin maintenance.
Now the results of a new study are out. It’s the Randomised Injectable Opioid Treatment Trial (RIOTT), which not only tried heroin maintenance, but compared it to other options in a randomized controlled trial. It was for a group of hard core street heroin users and they received either supervised injectable heroin, supervised injectable methadone or optimised oral methadone.
No surprise that the injectable heroin group had, by far, the best results, and showed dramatically positive response in: retention, abstinence from street heroin, reduction of crime, reduction in crack use, and improved physical, mental health and social functioning.
Danny at Transform provides some perspective:
That should not be news to anyone. I realised during my third or fourth interview yesterday, that the feigned shock from radio presenters that the Great British Public would be funding heroin users â€˜addictionâ€™, should be as nothing compared to their real shock that we are all funding the prohibition that leads users to steal and compromises their health in the first place.
Whilst the presumed roll out is to be welcomed, one has to ask why it has taken so long to come to this conclusion. Evidence has existed for years that, for those assessed as having a clinical need, heroin prescribing will keep them alive, improve their health and wellbeing and reduce the collateral damage of their use to wider society.
Danny also pointed out some disturbing facts:
The substantially increased cost of prescribing injectable heroin, compared with oral methadone, must also be seen in the context of the Macfarlane Smith monopoly on the UK opiates market that the Department of Health buys from. That means that the UK pays well over the odds for our diamorphine (Â£12,000 a year per user), compared to the Dutch (Â£2000 a year for the same product). This artificial cost barrier has been a major political obstacle.
How stupid is that? We have a massive, dirt-cheap supply of poppies available just a short distance away in Afghanistan. Why do business with a drug cartel that has forced out all competition?
Note: I really don’t know how a heroin maintenance program would work as the full model for legalization (because it’s never been tried in that way – it’s always been limited to the hard core user), but it’s clear that heroin maintenance is an effective and valuable tool in drug policy, and should be included as part of any legalization or decriminalization plan.