The Swiss heroin trials

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7164.1011 (Published 10 October 1998) Cite this as: BMJ 1998;317:1011

Trial is needed comparing decriminalisation of heroin with existing policy of prohibition

  1. G R Venning, Consultant in pharmaceutical medicine.
  1. Pharmaceutical Research Services, High Wycombe, Buckinghamshire HP13 6QG
  2. Alcohol and Drug Service, St Vincent's Hospital, Sydney, NSW 2010, Australia
  3. National Drug and Alcohol Research Centre, Sydney, Australia
  4. National Addiction Centre, Institute of Psychiatry, London SE5 8AF

    Editor—Farrell and Hall seem to have misunderstood the importance of the Swiss trials of heroin on prescription for addicts.1 The call for a clinical trial of heroin versus methadone is irrelevant as these drugs cater for different segments of the addict population; no one suggests stopping methadone clinics. It is self evident that prescribing heroin will attract addicts who need the “buzz” and will not switch to methadone. These include dealers and pushers and those who succeed in obtaining funds through crime. Methadone clinics attract newer rather than hard core addicts. A logical policy for decriminalising heroin under medical supervision would have four steps: giving prescriptions of heroin to all addicts in or out of prison (which would gradually put criminals out of business); providing methadone clinics for those who will switch; weaning the addicts off the drugs; and providing a follow up programme to minimise relapse. The trial that is needed would compare a city region or country adopting this approach with a similar community continuing the existing policy of prohibition. This policy has already failed for the same reason that prohibition failed in the United States: it created an opportunity for the criminal mafias who dominate the drug scene. The end points of a comparative trial should not be narrowly defined as conceived by Farrell and Hall; they should include the numbers of new addicts, mortality and morbidity among addicts and former addicts, …

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