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

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 rates during the heroin handout. We are not given data on criminality or breadth of illegal drugs used.

Fundamentally, the medical world needs to understand that heroin handouts are simply keeping addicts addicted. As seen in Switzerland, heroin handouts simply further the addiction and enslavement of suffering addicts.² Creative approaches such as those used in Sweden should be examined and implemented to press users more rigorously towards abstinence.³

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

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

---

Competing interests: None declared.

References

1. Van den Brink W, Henricks VM, Blanken P, Koeter MWJ, van Zwieten BJ, van Ree JM. Medical prescription of heroin to treatment resistant heroin addicts: two randomised controlled trials. BMJ 2003;327: 310-2. (9 August.)[Abstract/Free Full Text]
2. Satel SL, Aeschbach E. The Swiss heroin trials: scientifically sound? J Subst Abuse Treat 1999;17: 331-5.[Medline]
3. Sullivan L. Drug policy: a tale of two countries. News Weekly 1999 Aug 28: 7.

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