Germany: Heroin OK For Clinical Treatment Of Addicts

A vote in the German Bundestag yesterday, passed by a margin of 349 to 198, the use of heroin as a medical instrument in the treatment of long term addicts. A practice seen by many as the ultimate harm reduction measure for heroin addicts.

To qualify for this ground-breaking treatment the addict must be over 25 years of age, a registered addict for at least 5 years, and he or she must also have tried and failed at least 2 other common addiction treatments.

These may include methadone and buprenorphine.

A cross-party group of supporters says pilot programs in seven German cities found that controlled prescription of synthetic heroin, or diamorphine, at approved facilities helped addicts who failed to respond to treatment with methadone.


Neighboring Switzerland has long had similar programs. They have been credited with reducing drug-related crime and improving addicts' health, as has the 'shooting gallery'

scheme which operated in London recently, in which addicts were found to be over 70% less likely to commit crimes if they had a clean supply of clincal heroin as well as the necessary paraphernalia needed to ensure needle sharing doesn't take place.

The London scheme also had trained medical staff on site to advise addicts on the safest way to administer the diamorphine.

EURODRUG - INFORMATION LIST OF THE EUROPEAN COALITION FOR JUST AND EFFECTIVE DRUG POLICIES

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Canna Zine News

5/29/2009



http://pr.cannazine.co.uk/200905291...oin-ok-for-clinical-treatment-of-addicts.html

I wonder if the supply centers ever get robbed. Does anyone know?

FDRinTRINIDAD said:

I wonder if the supply centers ever get robbed. Does anyone know?

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No. They take very harsh security measures to ensure the safety and integrity of the Diamorphine, in transit and on site. It'd be a pretty foolish thing to do anyway. The amount of cameras alone. Plus the only benefit of doing so would be to sell it; and police snitches would certainly pick up who was trying to sell 'Pharmaceutical Heroin' quickly. That and the amount on site isn't that big. A regular European pharmacy has more potent opioids on hand than such a clinic, and would be easier to get away with.

FDRinTRINIDAD said:

I wonder if the supply centers ever get robbed. Does anyone know?

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* pulls ski mask out of the closet *

Sounds great! My home country finally taking a step in the right direction as well. I like the harm reduction approach! Maybe some will come around when I go visit again this summer

i dont understand... soon there will be clinics stocked with methamphetamine or cocaine.. when will it end??

the requirements are 5 years of addiction and 2 rehab failures... so many people succeed in rehab after their 2nd attempt.. these addicts are even allowed to use needles!

i think this will motivate addicts in the wrong way: i.e.- lets suppose someone has been addicted fr 3 to 4 yrs and is tiring of the lifestyle.. they dont want to be sick, they dont want to be criminals.. but they want to do heroin. the solution? struggle through another yr or 2 of addiction and get the drugs from the good old heroin clinic.

BeenArrested4Pot said:

i dont understand... soon there will be clinics stocked with methamphetamine or cocaine.. when will it end??

the requirements are 5 years of addiction and 2 rehab failures... so many people succeed in rehab after their 2nd attempt.. these addicts are even allowed to use needles!

i think this will motivate addicts in the wrong way: i.e.- lets suppose someone has been addicted fr 3 to 4 yrs and is tiring of the lifestyle.. they dont want to be sick, they dont want to be criminals.. but they want to do heroin. the solution? struggle through another yr or 2 of addiction and get the drugs from the good old heroin clinic.

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Your presumptions are false. The majority of people do not succeed after dozens of attempts at any rehab, detox or treatment. Around or less than 10% of people who seek traditional, non Opiate Replacement Therapies for addiction succeed. Heroin addicts in a Methadone, Buprenorphine or Heroin (or other opioid) replacement therapy have the best success rates of any addict to any drug undergoing any form of treatment.

Decades of studies, trials and experience have proven the cost to society and the individuals health and stability drop when patient compliance is the primary concern. In areas where Heroin maintenance programs, Methadone maintenance programs and Buprenorphine maintenance programs are established, there is a direct correlation between the treatment availibility and a drop in crime, new HIV cases, sharing of dirty needles, etc.

2/3 of the people enrolled in the Swiss Heroin maintenance program gained employment within a year of starting the program.

The benefits are to the addict and to society are so drastic, it is insane not to promote such programs. Methadone and Buprenorphine are both wonderful medications that have increased the stability, health standards and living standards of millions of opioid addicts. However, there is still a very large population of Heroin and other opioid addicts who have tried these treatments and did not find them satisfactory. This is the population generally most involved in crime, most likely to be infected with HIV/AIDS, Hepatitis, etc, most likely to have the lowest standard of health and living of the entire addict population. This is the best option for everyone.

Plus, most people enrolled in the Heroin maintenance program choose voluntarily to leave it for another treatment or to quit altogether within a year of starting.

There is no reasonable argument against maintenance treatment using Diamorphine.

but, OMG ur givin junkies wat they want! u kan't do that junkies r BAD PEOPLE!

8)

Tchort said:

Plus, most people enrolled in the Heroin maintenance program choose voluntarily to leave it for another treatment or to quit altogether within a year of starting.

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I seriously doubt that most people choose to voluntarily quit after one year, especially considering participants must have been addicted for a minimum of five documented years, in addition to the time spent abusing opiates without documentation.

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 don't believe it because you are basing your opinion of this program on drug war propaganda, not the facts.

First one example of a study where a sizeable percentage left unlimited amounts of prescription Heroin for other treatments.

More than half of the drop outs switched to another treatment.
By the end of 1996, a total of 83 people had decided to give up heroin and switch to abstinence therapy. The probability of this switch to abstinence therapy grows as the duration of individual treatment increases.
The longer a patient remains in treatment, the more the rate of drop outs and exclusions from treatment decreases.

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http://www.drugpolicy.org/library/presumm.cfm

Some other important, proven information about Heroin prescription programs.

In late 1994, the Social Welfare Department in Zurich held a press conference to issue its preliminary findings: 1) Heroin prescription is feasible, and has produced no black market in diverted heroin. 2) The health of the addicts in the program has clearly improved. 3) Heroin prescription alone cannot solve the problems that led to the heroin addiction in the first place. 4) Heroin prescription is less a medical program than a social-psychological approach to a complex personal and social problem. 5) Heroin per se causes very few, if any, problems when it is used in a controlled fashion and administered in hygienic conditions. Program administrators also found little support for the widespread belief that addicts' cravings for heroin are insatiable. When offered practically unlimited amounts of heroin (up to 300 milligrams three times a day), addicts soon realized that the maximum doses provided less of a "flash" than lower doses, and cut back their dosage levels accordingly.

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http://www.drugpolicy.org/library/tlcnr.cfm


This study showed Heroin addicts put on a waiting list for Heroin maintenance treatment often decided they did not want or need it and so gave up the option of having low cost or free Heroin, in any amount, to inject 3 times a day.

the Geneva researchers found that 62% of their controls declined to switch to heroin maintenance when it became available to them after 6 months. "Most were successfully treated in methadone maintenance programs" and wanted to stop injecting drugs

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http://www.nationalfamilies.org/publications/by_nfia/prescribing_heroin.html

What advantages does heroin maintenance entail in comparison to more traditional maintenance programs, such as methadone?

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Some people simply aren't ready for maintenance with a different opiate. They first have to exhaust the allure of heroin, and heroin maintenance provides an opportunity to do just that. The fact that most choose to abstain completely or move to a different maintenance program proves that.
You have to take into account the fundamental difference between traditional maintenance programs(methadone, bupe, laam), which is their long half life and the lack of ups and downs associated with heroin(and other common opiates of abuse). Maintaining by definition is keeping a stable dose of the drug in your system, possible with all opiates, but much easier with some than others.

Sure some people join the program for the high, but eventually as other aspects of their life start to improve and perhaps they even start figuring out the underlying causes of their addiction, it becomes more of a burden to dose 3 times a day than anything else and they chose other alternatives.

Perhaps if people look at this as a stepping stone on the path to abstinence, it would make more sense. This isn't a magic bullet designed to end heroin addiction.

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.

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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.

BeenArrested4Pot said:

i dont understand... soon there will be clinics stocked with methamphetamine or cocaine.. when will it end??

the requirements are 5 years of addiction and 2 rehab failures... so many people succeed in rehab after their 2nd attempt.. these addicts are even allowed to use needles!

i think this will motivate addicts in the wrong way: i.e.- lets suppose someone has been addicted fr 3 to 4 yrs and is tiring of the lifestyle.. they dont want to be sick, they dont want to be criminals.. but they want to do heroin. the solution? struggle through another yr or 2 of addiction and get the drugs from the good old heroin clinic.

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I think this is for the best, far less crime considering there will be far less dope sick people out there. At the same time though you are right, if youve been in the usual love hate relationship with it for years but there is this light at the end of the tunnel of free clean heroin it might kill some peoples motivation to kick it for good

Good points on both ends. I understand Germany has a socialized health care system. This seems like an attempt to ultimately save money, both in health care, and law enforcement / prison. I think it is putting a band-aide on the issue, but I'm interested to see what happens. Americas prohibition approach has proven to be a huge fail, so I guess anything's worth a shot.

Trial and error in my eyes...

Unknown said:

Good points on both ends. I understand Germany has a socialized health care system. This seems like an attempt to ultimately save money, both in health care, and law enforcement / prison. I think it is putting a band-aide on the issue, but I'm interested to see what happens. Americas prohibition approach has proven to be a huge fail, so I guess anything's worth a shot.

Trial and error in my eyes...

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What would be a solution in your opinion? Do you believe that it is possible to stop all recreational drug use? To eradicate addiction as a disease?

The British system from the 1920s was to put addicts in treatment (drug of choice maintenance, access to harm reduction focused health care and services), and arrest anyone caught selling illicit drugs. By doing this, they kept the number of new addict cases low and kept the number of drug dealers on the street low, without overfilling the prisons (since drug users not dealers are the multitudes locked up for drug crimes).

In my opinion this is the ideal system, and it was the first response to the original social drug problem; now almost a hundred years later we're revisiting it.

NextLineIsMine said:

I think this is for the best, far less crime considering there will be far less dope sick people out there. At the same time though you are right, if youve been in the usual love hate relationship with it for years but there is this light at the end of the tunnel of free clean heroin it might kill some peoples motivation to kick it for good

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Make it pure and legal, remove the stigmaticizing social aspect, and wtf should any heroin user need or have to want to ever quit?

Tchort said:

However, in the UK, it is permissable for doctors to prescribe IV Heroin ampoules outpatient.

Risk of diversion is 0% when the consumption rooms are used as part of the protocol.

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...yet select UK junkies can walk out with pure dia-ampules and there's NO reason ever that they'd sell it to the streets for I don't know, like 100% profit? Said junky would be retarded to waste it on NOT him/herself; I'm just saying.

DexterMeth said:

...yet select UK junkies can walk out with pure dia-ampules and there's NO reason ever that they'd sell it to the streets for I don't know, like 100% profit? Said junky would be retarded to waste it on NOT him/herself; I'm just saying.

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Thats why clinics are being established as an alternative to outpatient ampoules. The other benefits of a clinic setting rather than outpatient prescribing are 1) the patients consume their dose in the presence of a medical professional so theres no chance for diversion 2) there are doctors and nurses on staff at the clinic who can attend to the individual physical and mental health needs of the patients.

To your previous reply, you are missing aspects of maintenance treatment.

Not everyone who undergoes Opiate Replacement Therapy (i.e. opioid maintenance) wishes to end their use of opioids forever. Some just want to reregulate their use, some want to take a break from the street hustle, some want a break from using to attend to personal matters, some need maintenance rather than abstinence-only treatment indefinitely to hold their lives together (job, family, etc).

These are all acceptable uses for opioid maintenance programs. Including Diamorphine maintenance.

As I posted above, the studies done with actual Heroin maintenance programs showed that many people voluntarily left the IV Heroin program to enter abstinence-only and Methadone maintenance programs instead, using the IV Heroin maintenance program simply as a first step in the ladder of getting clean, or regulating or reducing their use.

The idea that Heroin users will never stop using if they can have free unlimited quantities of pure Heroin is false, and has been proven false with the existing Heroin maintenance programs. Most people in the Swiss permanent Heroin maintenance program don't stay in it for more than 2 years (which is also the average time people spend on Methadone maintenance).

Tchort said:

What would be a solution in your opinion? Do you believe that it is possible to stop all recreational drug use? To eradicate addiction as a disease?

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Absoultely not. Nor should it be fostered and encouraged with open arms through heroin maintenance. Yes maintenance programs imrpove addicts' quality of life and reduce crime rates. That is common knowledge. This got off topic into a maintenance versus rehab war...

The argument surrounds DIAMORPHINE maintenance, the maintenance that is supposed to help people quit the exact drug being distributed in the clinic. The program is designed to resolve a heroin addict's addiction. The only thing the clinic does is clean the needles and get him high. You can throw any statistic you desire at me but that system has an incredible potential for abuse.

Desperate addicts are willing to do some pretty fucked up things when they are fiending and if they had an opportunity to get three extra shots of morphine a day they would sure as hell do it! I think the heroin clinincs will ultimatey prolong addiction.

I have to ask are the maintenance programs for eliminating heroin addiction or are they for maintaining them while improving the quality of the lives of addicts. I suspect its both.

And lastly, if the heroin maintenance program is a viable solution, then why is cocaine maintenance not the solution? Methamphetmine maintenance? Marijuana maintenance? Hell, magic mushroom or LSD maintenance? What sets heroin apart from these drugs? I suppose its because some of those drugs are harder on the body. Others are not harmful enough to justify maintenance prgrams... But this is all subjective, who decides what drugs are worthy of maintenance programs?

^
Are you for (all) drug legalization?