Intended for healthcare professionals


Dutch report advises prescribing heroin for misusers

BMJ 1995; 310 doi: (Published 24 June 1995) Cite this as: BMJ 1995;310:1625

Strictly controlled medical experiments prescribing heroin to a small number of drug misusers should go ahead in the Netherlands, says an advisory report for the Dutch government. Doctors, psychologists, and experts in drug misuse spent a year investigating the value of experiments for the government's scientific advisory body, the Gezondheidsraad (the health council). It decided, from the sparse published reports and limited experience in Britain and Switzerland, that there was no evidence that prescribing heroin on medical grounds was harmful. Yet neither was there any proof of the benefits. But the group argues that additional treatment is needed as current options are failing some misusers.

The aim is to offer hope of treatment to a few of the 21000-25000 heroin users for whom methadone treatment and other programmes have failed. About 12500 heroin users are on methadone programmes while another 4500 have psychosocial counselling. But up to 5000 others are not being reached by medical services.

The health council wants the government to fund experiments in several cities but to restrict the overall number of people taking part to a maximum of 500. Heroin would be prescribed in injectable and non-injectable forms in a clinic up to three times a day. A contract would be drawn up between the doctor and the drug user, covering the duration and objectives of the experiment and the rights and responsibilities of both parties.

The drug users would be strictly supervised and encouraged to find housing and education. In this way regular contact could be re-established, and the spread of AIDS, tuberculosis, and hepatitis C might be prevented. A control group would be prescribed oral methadone. The experiments would be overseen by medical ethics committees as well as national and international experts and evaluated by an independent research organisation.

The health secretary, Professor Els Borst-Eilers, formerly a vice chairperson of the health council, has said that if the scientific advice supports the idea she will back medical experiments for patients who are “incurable addicts.” A majority in parliament supports the experiments, and public health departments in several cities including Amsterdam and Rotterdam have prepared plans.

Professor Willem van den Brink, chairperson of the council's committee on pharmacological interventions in heroin misusers, said that its role was to consider the prescription of heroin as a medical treatment for drug dependency. It did not take a view on the legalisation of heroin or the wider national debate about liberalising the drug policy. “We want to have a medical scientific experiment with a restricted number of people to see if there can be an improvement in their social integration and degree of criminality.”

Mr Bert Minjon, managing director of the outpatients department of the Jellinek Centre, Amsterdam's largest drug agency, welcomed the report, saying that a group of clients could be selected and a pilot project launched within a year. “There is a small but very visible group of drug users who may have been addicted for more than 10 years and whom social services cannot reach. We need to make contact with these people,” he said.—TONY SHELDON, freelance journalist, Utrecht

The current options are failing some heroin misusers


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