What advantages does heroin maintenance entail in comparison to more traditional maintenance programs, such as methadone? If people are leaving the heroin clinics for alternative treatment this means the heroin clinic is ineffective, burdensome, or otherwise unsatisfactory to patients. Presumably this is because patients realize that perhaps the best way to recover from heroin addiction is to ... stop using heroin. I would especially like to know specific percentages about the program's former patients. Not '2/3 left the clinic for other treatment or quit altogether' I would like to know what percentage left the clinic for other treatment (treatment did not work) and what percentage quit altogether (treatment did work). It makes no sense to combine them.
What are the prinicple differences between a batch of pure street heroin and pharmaceutical diamorphine [other than a surgeon general's warning]? What are the specific differences between diacetylmorphine and diamorphine? Do patients live there or do they pick the heroin up and leave? Does the pharmaceutical heroin ever make its way into the streets or is it administered on site? Do patients return to the clinic multiple times daily? If not, how do patients deal with withdrawals from short-acting heroin comparison to long acting methadone? Does it vary from one clinic to the next? The answers to these questions are vital to correctly interpret the large amount of patients leaving within one year of treatment.
You seem to miss the point. Harm reduction and an introduction to treatment is the purpose. Despite the best efforts of the medical community to approach Heroin addiction, there has always been a minority of Heroin addicts that seek treatment who are not helped by existing treatments and medications. It is believed that Heroin maintenance, temporarily or indefinitely, is the only way to get such people introduced to any form of treatment- where they can then access clean , fresh injecting equipment, pharmaceutical grade drugs over impure illicit street drugs, access to medical care and other social services.
Also, the goal of treatment is not always and shouldn't always be complete abstinence. Harm reduction. It is up to the individual what they want to get out of treatment. Many people go on Methadone maintenance simply to take a break from the Heroin subculture, or to reduce their use, etc. It is not always to stop using forever.
The health benefits, social benefits, etc of Opiate Replacement Therapy maintenance are undeniable. Addicts enrolled in maintenance programs commit less crime, abuse other drugs less, are more often going to be employed, and so on.
Just because a person opts to quit a Heroin maintenance program doesn't mean 'it doesn't work' at all. As Phrozen points out, the main purpose of Heroin maintenance is to be the first step for addicts who haven't been helped by other treatment modalities. I cannot find the link to the study that put the number of patients who opted out of Heroin maintenance to go to oral Methadone maintenance after a year at 60%.
This is a sign of progress. A patient who failed at going from illicit IV Heroin addiction to oral Methadone maintenance, then has a better chance to succeed at whatever their goal is (be it complete abstinence, or reduced usage, or a break from using, etc).
The programs are all different in their specific protocol. Most of these programs involve a clinic, where a patient comes to the clinic, injects their dose of Heroin under the supervision of a nurse, then leaves. They have to do this 3 times a day.
However, in the UK, it is permissable for doctors to prescribe IV Heroin ampoules outpatient.
The difference between street Heroin and medical grade Heroin should be obvious. Street Heroin is completely flux; there is no quality control, no standards. It can contain anything, and any amount of Diacetylmorphine. In a Heroin maintenance program, the prescription Heroin is 100% Diacetylmorphine, the patient uses a stable, known dosage everyday. This in itself is a big step up in terms of harm reduction.
Risk of diversion is 0% when the consumption rooms are used as part of the protocol.