BMJ  2004;328:229 (24 January), doi:10.1136/bmj.328.7433.229

Letter

Prescription of heroin to treatment resistant heroin addicts

Heroin handouts are flawed policy

The first 150 words of the full text of this article appear below.

EDITOR—We question the conclusions of van den Brink et al, who say that the use of heroin is comparable or perhaps better than methadone for resistant addicts.¹ Their measures of efficacy should raise serious questions as to the validity of the study. Deterioration of up to 40% in performance measure, or increases of cocaine or amphetamine of up to 20%, were deemed successes as long as at least one of three measures improved by at least 40%.

To consider deterioration of performance measures of up to 40% as acceptable smacks of manipulating measures of success to fit the data. A 40% deterioration is staggering and should be considered a clear failure.

Finally, even the authors concede that 45-88% of the participants did not respond to the heroin handout, yet they consider it a success. We are also not presented with the hard data on HIV or hepatitis conversion . . . [Full text of this article]

Internal Medicine and Addiction Medicine, Institute on Global Drug Policy, St Petersburg, FL 33701, USA EVoth@stormontvail.org

Private Practice of Psychiatry, Bettackerstrasse 7, CH-8152 Glattbrugg, Switzerland

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