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  1. Jürgen Rehm, chair1,
  2. Benedikt Fischer, professor12
  1. 1Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
  2. 2 Centre for Addictions Research of British Columbia, University of Victoria, Canada
  1. Correspondence to: J Rehm jtrehm{at}aol.com

    Some heroin addicts are very difficult to treat. Jürgen Rehm and Benedikt Fischer believe that maintenance with heroin is the way forward for this group, but Neil McKeganey argues that it is treating the effects of misuse not the addiction

    Recently, a public hearing of a Danish parliament subcommittee discussed whether heroin assisted maintenance treatment should be offered experimentally to reduce health and social harm related to use of heroin (www.tekno.dk/ordineret-heroin). This is just one in a series of similar—existing or proposed—programmes in Europe, North America, and Australia.1 We believe that such treatment is appropriate for heroin misusers under certain circumstances.

    Supporting evidence

    Increasing heroin misuse in the United States in the early 1970s led to a public debate about prescribing heroin as a last resort form of opioid maintenance therapy for people with chronic heroin dependence. In 1973 Lorrin Koran advocated in the New England Journal of Medicine that “carefully designed clinical research on the safety and efficacy of heroin maintenance should be undertaken, particularly with addicts not helped in …

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